Relationship between functional status prior to onset of critical illness and mortality: a prospective multicentre cohort study.

This prospective study aimed to assess the association between prior functional status and hospital mortality for patients admitted to four intensive care units in Spain between 2006 and 2012. Prior functional status was classified into three groups, using a modification of the Glasgow Outcome Scale (GOS), including group 1 with no limitations on activities of daily living; group 2 with some limitations but self-sufficient; and group 3 who were dependent on others for their activities of daily living. Of the 1,757 patients considered (mean Simplified Acute Physiology Score [SAPS] predicted mortality 14.8% and hospital mortality 13.7%), group 1 had the lowest observed hospital mortality (8.3%) compared to the SAPS 3 predicted mortality (11.6%). The observed mortality for group 2 (20.6%) and group 3 (27.4%) were both higher than predicted (19.2% and 21.2% respectively; odds ratio [OR] 1.97, 95% confidence interval [CI] 1.38-2.82 for group 2 and OR 2.90, 95% CI 1.78-4.72 for group 3 compared to group 1). Combining prior functional status and Sequential Organ Failure Assessment (SOFA) score with SAPS 3 further improved the ability of the SAPS 3 scores in predicting hospital mortality (area under the receiver operating characteristic curve 0.85 [95% CI 0.82-0.88] versus 0.84 [95% CI 0.81-0.87] respectively). In summary, patients with limited functional status prior to ICU admission had a higher risk of observed hospital mortality than predicted. Assessing prior functional status using a relatively simple questionnaire, such as a modified GOS, has the potential to improve the accuracy of existing prognostic models.

External validation of the Simplified Acute Physiology Score (SAPS) 3 in Spain

OBJECTIVE: To evaluate SAPS 3 performance in Spain, assessing discrimination and calibration in a multicenter study. DESIGN: A prospective, multicenter study was carried out. Patients and setting: A prospective cohort study was performed in Spanish hospitals between 2006 and 2011. Measurements and results: A total of 2171 patients were included in the study. The mean age was 61.4 ± 16.09 years, the ICU mortality was 11.6%, and hospital mortality 16.03%. The SAPS 3 score was 46.29 ± 14.34 points, with a probability of death for our geographical area of 18.57%, and 17.97% for the general equation. The differences between observed-to-predicted mortality were analyzed with the Hosmer-Lemeshow test, which yielded H = 31.71 (p < 0.05) for our geographical area and H = 20.05 (p < 0.05) for the general equation. SAPS 3 discrimination with regard to hospital mortality, tested using the area under the ROC curve, was 0.845 (0.821-0.869). CONCLUSION: Our study shows good discrimination of the SAPS 3 system in Spain, but also inadequate calibration, with differences between predicted and observed mortality. There are more similarities with regard to the general equation than with respect to our geographical area equation, and in both cases the SAPS 3 system overestimates mortality. According to our results, Spanish ICU mortality is lower than in other hospitals included in the multicenter study that developed the SAPS 3 system, in patients with similar characteristics and severity of illness

OBJETIVO: Analizar el funcionamiento del sistema SAPS3 en España, evaluando la discriminación y calibración en un estudio multicéntrico. DISEÑO: Estudio prospectivo de cohortes, multicéntrico. Ámbito: Hospitales españoles entre 2006 y 2011. Variables de interés y resultados: Se incluyó en el estudio a un total de 2171 pacientes. La edad media fue 61,4 ± 16,09 años, la mortalidad en UCI fue del 11,6% y la mortalidad hospitalaria 16,03%. El score SAPS 3 fue de 46,29 ± 14,34 puntos, con la probabilidad de morir por la ecuación de nuestra área geográfica 18.57%, y 17.97% para la ecuación general. Las diferencias entre la mortalidad observada y la predicha se analizaron mediante el test de Hosmer-Lemeshow. Este test mostró H = 31,71 (p < 0,05) para nuestra área geográfica y H = 20,05 (p < 0,05) para la ecuación general. La discriminación del SAPS 3 con respecto a la mortalidad hospitalaria, testada mediante el área bajo la curva ROC, fue 0.845 (0,821-0,869). CONCLUSIÓN: Nuestro estudio muestra, en España, una buena discriminación del sistema pronóstico SAPS 3 pero una inadecuada calibración, con diferencias entre la mortalidad predicha y, la observada. Hay más similitudes con respecto a la ecuación general que con la ecuación de nuestra zona geográfica, y en ambos casos, el sistema SAPS 3 sobreestima la mortalidad. De acuerdo con los resultados, la mortalidad en UCI es menor que la de otros hospitales incluidos en el estudio multicéntrico que se utilizaron para desarrollar el sistema SAPS 3, en pacientes con similares características y severidad de la enfermedad

External validation of the Simplified Acute Physiology Score (SAPS) 3 in Spain.

OBJECTIVE: To evaluate SAPS 3 performance in Spain, assessing discrimination and calibration in a multicenter study. DESIGN: A prospective, multicenter study was carried out. PATIENTS AND SETTING: A prospective cohort study was performed in Spanish hospitals between 2006 and 2011. MEASUREMENTS AND RESULTS: A total of 2171 patients were included in the study. The mean age was 61.4±16.09 years, the ICU mortality was 11.6%, and hospital mortality 16.03%. The SAPS 3 score was 46.29±14.34 points, with a probability of death for our geographical area of 18.57%, and 17.97% for the general equation. The differences between observed-to-predicted mortality were analyzed with the Hosmer-Lemeshow test, which yielded H=31.71 (p<0.05) for our geographical area and H=20.05 (p<0.05) for the general equation. SAPS 3 discrimination with regard to hospital mortality, tested using the area under the ROC curve, was 0.845 (0.821-0.869). CONCLUSION: Our study shows good discrimination of the SAPS 3 system in Spain, but also inadequate calibration, with differences between predicted and observed mortality. There are more similarities with regard to the general equation than with respect to our geographical area equation, and in both cases the SAPS 3 system overestimates mortality. According to our results, Spanish ICU mortality is lower than in other hospitals included in the multicenter study that developed the SAPS 3 system, in patients with similar characteristics and severity of illness.