title: Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals.
abstract: OBJECTIVE
  The SAPS 3 (Simplified Acute Physiology Score 3) prognostic system is composed of 20 parameters, represented by an acute physiology score and assessment of the previous status, aimed at establishing a predictive mortality index for patients admitted to intensive care units (ICU). The objective of this study was to validate this system and determine its discriminatory power in surgical patients in Brazil.
  
  
  METHODS
  This is a prospective study undertaken in two surgical ICUs of two different hospitals over a one-year period; patients younger than 16 years, who stay at the ICU for less than 24 hours, readmitted to the unit, and those admitted for dialysis were excluded from the study. The predictive ability of the SAPS 3 index to differentiate survivors and non-survivors was determined by the ROC curve and calibration by the Hosmer-Lemeshow goodness-of-fit test.
  
  
  RESULTS
  One thousand three-hundred and ten patients were included in the study. Gastrointestinal surgeries predominated (34.9%). Eighteen was the lower SAPS 3 index and the highest was 154, with a mean of 48.5 +/- 18.1. The predicted and real hospital mortality was 10.3% and 10.8%, respectively; the standardized mortality ratio (SMR) was 1.04 (95%CI = 1.03-1.07). Calibration by the Hosmer and Lemeshow method showed X(2) = 10.47 p = 0.234. The SAPS 3 score that better discriminated survivors and non-survivors was 57, with sensitivity of 75.8% and specificity 86%. Among the patients with SAPS 3 index higher than 57, 73.5% did not survive versus 26.5% who survived (OR= 1.32, 95%CI 1.23-1.42, p < 0.0001).
  
  
  CONCLUSIONS
  The SAPS 3 system is valid for the Brazilian population of surgical patients, being a useful indicator of critical patients and to determine greater care in this group.
authors.affiliation: Serviço de Anestesiologia do Hospital do Servidor Público Estadual Francisco Morato de Oliveira (HSPE), São Paulo, SP. Joao.s@usp.br
authors.forename: João Manoel
authors.initials: JM
authors.lastname: Silva Junior
authors.forename: Luiz M Sá
authors.initials: LM
authors.lastname: Malbouisson
authors.forename: Hector L
authors.initials: HL
authors.lastname: Nuevo
authors.forename: Luiz Gustavo T
authors.initials: LG
authors.lastname: Barbosa
authors.forename: Lauro Yoiti
authors.initials: LY
authors.lastname: Marubayashi
authors.forename: Isabel Cristina
authors.initials: IC
authors.lastname: Teixeira
authors.forename: Antonio Paulo
authors.initials: AP
authors.lastname: Nassar Junior
authors.forename: Maria Jose Carvalho
authors.initials: MJ
authors.lastname: Carmona
authors.forename: Israel Ferreira da
authors.initials: IF
authors.lastname: Silva
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler Júnior
authors.forename: Ederlon
authors.initials: E
authors.lastname: Rezende
mesh_terms: D000368:Aged; D001938:Brazil; D005260:Female; D006304:Health Status; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies