Escalas pronósticas en la disfunción multiorgánica: estudio de cohortes / Predictive scoring systems in multiorgan failure: A cohort study

OBJETIVO: Valorar el grado en que las escalas pronósticas son capaces de predecir la mortalidad hospitalaria. DISEÑO: Estudio de cohortes retrospectivo de 2 años. ÁMBITO: UCI médico-quirúrgica de un hospital de tercer nivel. PACIENTES: Todos los pacientes con síndrome de disfunción multiorgánica en el primer día de ingreso. Variables de interés: APACHE II y IV, SAPS II y III, MPM II y muerte hospitalaria. RESULTADOS: Se incluyeron 568 pacientes. Mortalidad hospitalaria: 39,8% (226 pacientes). Discriminación (área bajo la curva; IC 95%): APACHE IV (0,805; 0,751-0,858), SAPS II (0,755; 0,697-0,814), MPM II (0,748; 0,688-0,809), SAPS III (0,737; 0,675-0,799) y APACHE II (0,699; 0,633-0,765). El MPM II es el que mejor calibra, seguido por el SAPS III. APACHE II, SAPS II y APACHE IV presentan una muy mala calibración. Razón estandarizada de mortalidad (IC 95%): APACHE IV 1,9 (1,78-2,02); APACHE II 1,1 (1,07-1,13); SAPS III 1,1 (1,06-1,14); SAPS II 1,03 (1,01-1,05); MPM 0,9 (0,86-0,94). CONCLUSIONES: APACHE IV tiene la mejor capacidad discriminativa y mala calibración. MPM II tiene una buena discriminación y la mejor calibración. En cuanto al SAPS II, mantiene la segunda mejor discriminación y una mala calibración. El APACHE II muestra unos valores de calibración y discriminación que desaconsejarían su utilización en la actualidad, y el SAPS III mantiene una adecuada calibración y una discriminación moderada. La valoración de estos resultados podría marcar el inicio de nuevos estudios a nivel regional/nacional en determinadas poblaciones de pacientes críticos

OBJECTIVE: An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems. DESIGN: A 2-year retrospective cohort study was carried out. SETTING: A third level ICU with surgical and medical patients. PATIENTS: All patients with multiorgan failure during the first day in the ICU. Main variables: APACHE II and IV, SAPS II and III, MPM II and hospital mortality. RESULTS: A total of 568 patients were included. Mortality rate: 39.8% (226 patients). Discrimination (area under the ROC curve; 95% CI): APACHE IV (0.805; 0.751-0.858), SAPS II (0.755; 0.697-0.814), MPM II (0.748; 0.688-0.809), SAPS III (0.737; 0.675-0.799) and APACHE II (0.699; 0.633-0.765). MPM II showed the best calibration, followed by SAPS III. APACHE II, SAPS II and APACHE IV showed very poor calibration. Standard mortality ratio (95% CI): APACHE IV 1.9 (1.78-2.02); APACHE II 1.1 (1.07-1.13); SAPS III 1.1 (1.06-1.14); SAPS II 1.03 (1.01-1.05); MPM 0.9 (0.86-0.94). CONCLUSIONS: APACHE IV showed the best discrimination, with poor calibration. MPM II showed good discrimination and the best calibration. SAPS II, in turn, showed the second best discrimination, with poor calibration. The APACHE II calibration and discrimination values currently disadvise its use. SAPS III showed good calibration with modest discrimination. Future studies at regional or national level and in certain critically ill populations are needed

Predictive scoring systems in multiorgan failure: A cohort study.

OBJECTIVE: An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems. DESIGN: A 2-year retrospective cohort study was carried out. SETTING: A third level ICU with surgical and medical patients. PATIENTS: All patients with multiorgan failure during the first day in the ICU. MAIN VARIABLES: APACHE II and IV, SAPS II and III, MPM II and hospital mortality. RESULTS: A total of 568 patients were included. Mortality rate: 39.8% (226 patients). Discrimination (area under the ROC curve; 95% CI): APACHE IV (0.805; 0.751-0.858), SAPS II (0.755; 0.697-0.814), MPM II (0.748; 0.688-0.809), SAPS III (0.737; 0.675-0.799) and APACHE II (0.699; 0.633-0.765). MPM II showed the best calibration, followed by SAPS III. APACHE II, SAPS II and APACHE IV showed very poor calibration. Standard mortality ratio (95% CI): APACHE IV 1.9 (1.78-2.02); APACHE II 1.1 (1.07-1.13); SAPS III 1.1 (1.06-1.14); SAPS II 1.03 (1.01-1.05); MPM 0.9 (0.86-0.94). CONCLUSIONS: APACHE IV showed the best discrimination, with poor calibration. MPM II showed good discrimination and the best calibration. SAPS II, in turn, showed the second best discrimination, with poor calibration. The APACHE II calibration and discrimination values currently disadvise its use. SAPS III showed good calibration with modest discrimination. Future studies at regional or national level and in certain critically ill populations are needed.