title: Feasibility of transitioning from APACHE II to SAPS III as prognostic model in a Brazilian general intensive care unit. A retrospective study.
abstract: OBJECTIVE
  Prognostic models reflect the population characteristics of the countries from which they originate. Predictive models should be customized to fit the general population where they will be used. The aim here was to perform external validation on two predictive models and compare their performance in a mixed population of critically ill patients in Brazil.
  
  
  METHODS
  Retrospective study in a Brazilian general intensive care unit (ICU).
  
  
  METHODS
  This was a retrospective review of all patients admitted to a 41-bed mixed ICU from August 2011 to September 2012. Calibration (assessed using the Hosmer-Lemeshow goodness-of-fit test) and discrimination (assessed using area under the curve) of APACHE II and SAPS III were compared. The standardized mortality ratio (SMR) was calculated by dividing the number of observed deaths by the number of expected deaths.
  
  
  RESULTS
  A total of 3,333 ICU patients were enrolled. The Hosmer-Lemeshow goodness-of-fit test showed good calibration for all models in relation to hospital mortality. For in-hospital mortality there was a worse fit for APACHE II in clinical patients. Discrimination was better for SAPS III for in-ICU and in-hospital mortality (P = 0.042). The SMRs for the whole population were 0.27 (confidence interval [CI]: 0.23 - 0.33) for APACHE II and 0.28 (CI: 0.22 - 0.36) for SAPS III.
  
  
  CONCLUSIONS
  In this group of critically ill patients, SAPS III was a better prognostic score, with higher discrimination and calibration power.
authors.affiliation: Faculdade de Medicina do ABC, São Paulo, Brazil.
authors.forename: Ary
authors.initials: A
authors.lastname: Serpa Neto
authors.affiliation: Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Murillo Santucci Cesar de
authors.initials: MS
authors.lastname: Assunção
authors.affiliation: Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Andréia
authors.initials: A
authors.lastname: Pardini
authors.affiliation: Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Eliézer
authors.initials: E
authors.lastname: Silva
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002138:Calibration; D016638:Critical Illness / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies