Effectiveness of SAPS III to predict hospital mortality for post-cardiac arrest patients.
OBJECTIVE
The mortality for patients admitted to intensive care unit (ICU) after cardiac arrest (CA) remains high despite advances in resuscitation and post-resuscitation care. The Simplified Acute Physiology Score (SAPS) III is the only score that can predict hospital mortality within an hour of admission to ICU. The objective was to evaluate the performance of SAPS III to predict mortality for post-CA patients.


METHODS
This retrospective single-center observational study included all patients admitted to ICU after CA between August 2010 and March 2013. The calibration (standardized mortality ratio [SMR]) and the discrimination of SAPS III (area under the curve [AUC] for receiver operating characteristic [ROC]) were measured. Univariate logistic regression tested the relationship between death and scores for SAPS III, SAPS II, Sequential Organ Failure Assessment (SOFA) Score and Out-of-Hospital Cardiac Arrests (OHCA) score. Independent factors associated with mortality were determined.


RESULTS
One-hundred twenty-four patients including 97 out-of-hospital CA were included. In-hospital mortality was 69%. The SAPS III was unable to predict mortality (SMRSAPS III: 1.26) and was less discriminating than other scores (AUCSAPSIII: 0.62 [0.51, 0.73] vs.
0.75 [0.66, 0.84], AUCSOFA: 0.72 [0.63, 0.81], AUCOHCA: 0.84 [0.77, 0.91]). An early return of spontaneous circulation, early resuscitation care and initial ventricular arrhythmia were associated with a better prognosis.


CONCLUSIONS
The SAPS III did not predict mortality in patients admitted to ICU after CA. The amount of time before specialized CPR, the low-flow interval and the absence of an initial ventricular arrhythmia appeared to be independently associated with mortality and these factors should be used to predict mortality for these patients.
Aix-Marseille Université UMRD2, 13005 Marseille, France; Aix-Marseille Université, URMITE CNRS- UMR 7278, 13005 Marseille, France. Electronic address: magalibisbal@gmail.com.
Magali
M
Bisbal
APHM, Hôpital La Timone, CIC-UPCET, Pharmacologie Clinique et Evaluations Thérapeutiques, 13005 Marseille, France.
Elisabeth
E
Jouve
Aix-Marseille Univ, URMITE CNRS-UMR 7278, 13005 Marseille, France; APHM, Hôpital Nord, Réanimation, 13015 Marseille, France.
Laurent
L
Papazian
Aix-Marseille Université UMRD2, 13005 Marseille, France; Aix-Marseille Université, URMITE CNRS- UMR 7278, 13005 Marseille, France.
Sophie
S
de Bourmont
Aix-Marseille Université, URMITE CNRS- UMR 7278, 13005 Marseille, France.
Gilles
G
Perrin
Aix-Marseille Université, URMITE CNRS- UMR 7278, 13005 Marseille, France.
Beatrice
B
Eon
Aix-Marseille Université UMRD2, 13005 Marseille, France; Aix-Marseille Université, URMITE CNRS- UMR 7278, 13005 Marseille, France.
Marc
M
Gainnier
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D005260:Female; D005602:France; D006323:Heart Arrest / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index
Cardiac arrest; Mortality; SAPS II; SAPS III