title: Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study.
abstract: 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.
authors.affiliation: 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
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
authors.forename: Ulisses V A
authors.initials: UV
authors.lastname: Silva
authors.forename: José M M
authors.initials: JM
authors.lastname: Teles
authors.forename: Eliézer
authors.initials: E
authors.lastname: Silva
authors.forename: Pedro
authors.initials: P
authors.lastname: Caruso
authors.forename: Suzana M A
authors.initials: SM
authors.lastname: Lobo
authors.forename: Felipe
authors.initials: F
authors.lastname: Dal Pizzol
authors.forename: Luciano P
authors.initials: LP
authors.lastname: Azevedo
authors.forename: Frederico B
authors.initials: FB
authors.lastname: de Carvalho
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
mesh_terms: 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