Assessment of performance of four mortality prediction systems in a Saudi Arabian intensive care unit.
BACKGROUND
The purpose of this study is to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Mortality Probability Model MPM II0 and MPM II24 systems in a major tertiary care hospital in Riyadh, Saudi Arabia.


METHODS
The following data were collected prospectively on all consecutive patients admitted to the Intensive Care Unit between 1 March 1999 and 31 December 2000: demographics, APACHE II and SAPS II scores, MPM variables, ICU and hospital outcome. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit C statistics. Discrimination was evaluated by calculating the Area Under the Receiver Operating Characteristic Curves (ROC AUC).


RESULTS
Predicted mortality by all systems was not significantly different from actual mortality [SMR for MPM II0: 1.00 (0.91-1.10), APACHE II: 1.00 (0.8-1.11), SAPS II: 1.09 (0.97-1.21), MPM II24 0.92 (0.82-1.03)]. Calibration was best for MPM II24 (C-statistic: 14.71, P = 0.06). Discrimination was best for MPM II0 (ROC AUC:0.85) followed by MPM II24 (0.84), APACHE II (0.83) then SAPS II (0.79).


CONCLUSIONS
In our ICU population: 1) Overall mortality prediction, estimated by standardized mortality ratio, was accurate, especially for MPM II0 and APACHE II. 2) MPM II24 has the best calibration. 3) SAPS II has the lowest calibration and discrimination. The local performance of MPM II24 in addition to its ease-to-use makes it an attractive model for mortality prediction in Saudi Arabia.
Arabi
Yaseen
Y
Consultant ICU Program Director, Critical Care Fellowship, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. yaseenarabi@yahoo.com
Haddad
Samir
S
Goraj
Radoslaw
R
Al-Shimemeri
Abdullah
A
Al-Malik
Salim
S
D018806:APACHE; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012529:Saudi Arabia; D012720:Severity of Illness Index; D016019:Survival Analysis