External validation of the Simplified Acute Physiology Score (SAPS) 3 in a cohort of 28,357 patients from 147 Italian intensive care units.
OBJECTIVE
To evaluate the SAPS 3 score predictive ability of hospital mortality in a large external validation cohort.


METHODS
Prospective observational study.


METHODS
A total of 28,357 patients from 147 Italian ICUs joining the Project Margherita national database of the Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva (GiViTI).


METHODS
None.


METHODS
Evaluation of discrimination through ROC analysis and of overall goodness-of-fit through the Cox calibration test.


RESULTS
Although discrimination was good, calibration turned out to be poor. The general and the South-Europe Mediterranean countries equations overestimated hospital mortality overall (SMR values 0.73 with 95% CI 0.72-0.75 for both equations) and homogeneously across risk classes. Overprediction was confirmed among important subgroups, with SMR values ranging between 0.47 and 0.82.


CONCLUSIONS
The result strictly supported by our data is that the SAPS 3 score calibrates inadequately in a large sample of Italian ICU patients and thus should not be used for benchmarking, at least in Italian settings.
Poole
Daniele
D
Servizio Anestesia e Rianimazione, Ospedale Civile San Martino, Belluno, Italy. danest@libero.it
Rossi
Carlotta
C
Anghileri
Abramo
A
Giardino
Michele
M
Latronico
Nicola
N
Radrizzani
Danilo
D
Langer
Martin
M
Bertolini
Guido
G
D018806:APACHE; D000368:Aged; D015982:Bias; D002138:Calibration; D016009:Chi-Square Distribution; D003422:Critical Care / Q000458:organization & administration; D016638:Critical Illness / Q000145:classification / Q000401:mortality; D003625:Data Collection / Q000379:methods / Q000592:standards; D003953:Diagnosis-Related Groups; D016002:Discriminant Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors
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