title: Validation of SAPS3 admission score and its customization for use in Korean intensive care unit patients: a prospective multicentre study.
abstract: OBJECTIVE
  To externally validate the simplified acute physiology score 3 (SAPS3) and to customize it for use in Korean intensive care unit (ICU) patients.
  
  
  METHODS
  This is a prospective multicentre cohort study involving 22 ICUs from 15 centres throughout Korea. The study population comprised patients who were consecutively admitted to participating ICUs from 1 July 2010 to 31 January 2011.
  
  
  RESULTS
  A total of 4617 patients were enrolled. ICU mortality was 14.3%, and hospital mortality was 20.6%. The patients were randomly assigned into one of two cohorts: a development (n = 2309) or validation (n = 2308) cohort. In the development cohort, the general SAPS3 had good discrimination (area under the receiver operating characteristics curve = 0.829), but poor calibration (Hosmer-Lemeshow goodness-of-fit test H = 123.06, P < 0.001, C = 118.45, P < 0.001). The Australasia SAPS3 did not improve calibration (H = 73.53, P < 0.001, C = 70.52, P < 0.001). Customization was achieved by altering the logit of the original SAPS3 equation. The new equation for Korean ICU patients was validated in the validation cohort, and demonstrated both good discrimination (area under the receiver operating characteristics curve = 0.835) and good calibration (H = 4.61, P = 0.799, C = 5.67, P = 0.684).
  
  
  CONCLUSIONS
  General and regional Australasia SAPS3 admission scores showed poor calibration for use in Korean ICU patients, but the prognostic power of the SAPS3 was significantly improved by customization. Prediction models should be customized before being used to predict mortality in different regions of the world.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lim
authors.forename: Shin Ok
authors.initials: SO
authors.lastname: Koh
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.forename: Won-Il
authors.initials: WI
authors.lastname: Choi
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Seok Chan
authors.initials: SC
authors.lastname: Kim
authors.forename: Gyu Rak
authors.initials: GR
authors.lastname: Chon
authors.forename: Je Hyeong
authors.initials: JH
authors.lastname: Kim
authors.forename: Jae Yeol
authors.initials: JY
authors.lastname: Kim
authors.forename: Jaemin
authors.initials: J
authors.lastname: Lim
authors.forename: Chin Kook
authors.initials: CK
authors.lastname: Rhee
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Park
authors.forename: Ho Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Lee
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Jisook
authors.initials: J
authors.lastname: Park
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D007723:Korea; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: calibration; discrimination; intensive care unit; severity of illness