Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study.
OBJECTIVE
The aim of the present study was to validate the Simplified Acute Physiology Score II (SAPS II) and 3 (SAPS 3), the Mortality Probability Models III (MPM(0)-III), and the Cancer Mortality Model (CMM) in patients with cancer admitted to several intensive care units (ICU).


METHODS
Prospective multicenter cohort study.


METHODS
Twenty-eight ICUs in Brazil.


METHODS
Seven hundred and seventeen consecutive patients (solid tumors 93%; hematological malignancies 7%) included over a 2-month period.


METHODS
None.


RESULTS
Discrimination was assessed by area under receiver operating characteristic (AROC) curves and calibration by Hosmer-Lemeshow goodness-of-fit test. The main reasons for ICU admission were postoperative care (57%), sepsis (15%) and respiratory failure (10%). The ICU and hospital mortality rates were 21 and 30%, respectively. When all 717 patients were evaluated, discrimination was superior for both SAPS II (AROC = 0.84) and SAPS 3 (AROC = 0.84) scores compared to CMM (AROC = 0.79) and MPM(0)-III (AROC = 0.71) scores (P < 0.05 in all comparisons). Calibration was better using CMM and the customized equation of SAPS 3 score for South American countries (CSA). MPM(0)-III, SAPS II and standard SAPS 3 scores underestimated mortality (standardized mortality ratio, SMR > 1), while CMM tended to overestimation (SMR = 0.48). However, using the SAPS 3 for CSA resulted in more precise estimations of the probability of death [SMR = 1.02 (95% confidence interval = 0.87-1.19)]. Similar results were observed when scheduled surgical patients were excluded.


CONCLUSIONS
In this multicenter study, the customized equation of SAPS 3 score for CSA was found to be accurate in predicting outcomes in cancer patients requiring ICU admission.
Soares
Márcio
M
ICU, Hospital de Câncer-I, Instituto Nacional de Câncer, Centro de Tratamento Intensivo, 10 degrees Andar; Pça. Cruz Vermelha, 23, Rio de Janeiro, RJ, CEP 20230-130, Brazil. marciosoaresms@yahoo.com.br
Silva
Ulisses V A
UV
Teles
José M M
JM
Silva
Eliézer
E
Caruso
Pedro
P
Lobo
Suzana M A
SM
Dal Pizzol
Felipe
F
Azevedo
Luciano P
LP
de Carvalho
Frederico B
FB
Salluh
Jorge I F
JI
D018806:APACHE; D001938:Brazil / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality; D019370:Observation; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results