Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals.
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.
Silva Junior
João Manoel
JM
Serviço de Anestesiologia do Hospital do Servidor Público Estadual Francisco Morato de Oliveira (HSPE), São Paulo, SP. Joao.s@usp.br
Malbouisson
Luiz M Sá
LM
Nuevo
Hector L
HL
Barbosa
Luiz Gustavo T
LG
Marubayashi
Lauro Yoiti
LY
Teixeira
Isabel Cristina
IC
Nassar Junior
Antonio Paulo
AP
Carmona
Maria Jose Carvalho
MJ
Silva
Israel Ferreira da
IF
Auler Júnior
José Otávio Costa
JO
Rezende
Ederlon
E
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