Assessment of the prognosis of coronary patients: performance and customization of generic severity indexes.
OBJECTIVE
To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables.


METHODS
Inception cohort.


METHODS
Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands.


METHODS
Four hundred fifty-six patients with acute myocardial infarction.


RESULTS
The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones.


CONCLUSIONS
Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.
Sarmiento
X
X
Intensive Care Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Rué
M
M
Guardiola
J J
JJ
Toboso
J M
JM
Soler
M
M
Artigas
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002138:Calibration; D003327:Coronary Disease / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D013030:Spain