Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
PLoS One. 2019 Sep 25;14(9):e0222164. doi: 10.1371/journal.pone.0222164. eCollection 2019.
To analyze and compare the performance of the Simplified-Acute-Physiology-Score (SAPS) 2 and SAPS 3 among intermediate care patients with internal disorders.
We conducted a retrospective single-center analysis in patients (n = 305) admitted to an intermediate-care-unit (ImCU) for internal medicine at the University Hospital Essen, Germany. We employed and compared the SAPS 2 vs. the SAPS 3 scoring system for the assessment of disease severity and prediction of mortality rates among patients admitted to the ImCU within an 18-month period. Both scores, which utilize parameters recorded at admission to the intensive-care-unit (ICU), represent the most widely applied scoring systems in European intensive care medicine. The area-under-the-receiver-operating-characteristic-curve (AUROC) was used to evaluate the SAPS 2 and SAPS 3 discrimination performance. Ultimately, standardized-mortality-ratios (SMRs) were calculated alongside their respective 95%-confidence-intervals (95% CI) in order to determine the observed-to-expected death ratio and calibration belt plots were generated to evaluate the SAPS 2 and SAPS 3 calibration performance.
Both scores provided acceptable discrimination performance, i.e., the AUROC was 0.71 (95% CI, 0.65-0.77) for SAPS 2 and 0.77 (95% CI, 0.72-0.82) for SAPS 3. Against the observed in-hospital mortality of 30.2%, SAPS 2 showed a weak performance with a predicted mortality of 17.4% and a SMR of 1.74 (95% CI, 1.38-2.09), especially in association with liver diseases and/or sepsis. SAPS 3 performed accurately, resulting in a predicted mortality of 29.9% and a SMR of 1.01 (95% CI, 0.8-1.21). Based on Calibration belt plots, SAPS 2 showed a poor calibration-performance especially in patients with low mortality risk (P<0.001), while SAPS 3 exhibited a highly accurate calibration performance (P = 0.906) across all risk levels.
In our study, the SAPS 3 exhibited high accuracy in prediction of mortality in ImCU patients with internal disorders. In contrast, the SAPS 2 underestimated mortality particularly in patients with liver diseases and sepsis.
分析和比较简化急性生理学评分（SAPS）2 与 SAPS 3 在患有内科疾病的中间护理患者中的表现。
我们在德国埃森大学医院的内科中间护理病房（ImCU）进行了一项回顾性单中心分析，共纳入了 305 名患者。我们采用 SAPS 2 与 SAPS 3 评分系统来评估患者的疾病严重程度，并预测患者在 18 个月内入住 ImCU 的死亡率。这两个评分系统都使用了入住重症监护病房（ICU）时记录的参数，是欧洲重症监护医学中应用最广泛的评分系统。使用受试者工作特征曲线下面积（AUROC）评估 SAPS 2 和 SAPS 3 的区分性能。最终，计算了标准化死亡率比（SMR）及其各自的 95%置信区间（95%CI），以确定观察到的与预期的死亡比例，并生成校准带图以评估 SAPS 2 和 SAPS 3 的校准性能。
两种评分都提供了可接受的区分性能，即 SAPS 2 的 AUROC 为 0.71（95%CI，0.65-0.77），SAPS 3 的 AUROC 为 0.77（95%CI，0.72-0.82）。对于观察到的住院死亡率为 30.2%，SAPS 2 的表现较弱，预测死亡率为 17.4%，SMR 为 1.74（95%CI，1.38-2.09），尤其是在伴有肝脏疾病和/或败血症的情况下。SAPS 3 表现准确，预测死亡率为 29.9%，SMR 为 1.01（95%CI，0.8-1.21）。基于校准带图，SAPS 2 表现出较差的校准性能，尤其是在低死亡率风险的患者中（P<0.001），而 SAPS 3 则在所有风险水平上表现出高度准确的校准性能（P=0.906）。
在我们的研究中，SAPS 3 在预测患有内科疾病的中间护理患者的死亡率方面表现出高度的准确性。相比之下，SAPS 2 低估了死亡率，特别是在患有肝脏疾病和败血症的患者中。
