title: Simplified Acute Physiology Score II as Predictor of Mortality in Intensive Care Units: A Decision Curve Analysis.
abstract: BACKGROUND
  End-of-life decision-making in Intensive care Units (ICUs) is difficult. The main problems encountered are the lack of a reliable prediction score for death and the fact that the opinion of patients is rarely taken into consideration. The Decision Curve Analysis (DCA) is a recent method developed to evaluate the prediction models and which takes into account the wishes of patients (or surrogates) to expose themselves to the risk of obtaining a false result. Our objective was to evaluate the clinical usefulness, with DCA, of the Simplified Acute Physiology Score II (SAPS II) to predict ICU mortality.
  
  
  METHODS
  We conducted a retrospective cohort study from January 2011 to September 2015, in a medical-surgical 23-bed ICU at University Hospital. Performances of the SAPS II, a modified SAPS II (without AGE), and age to predict ICU mortality, were measured by a Receiver Operating Characteristic (ROC) analysis and DCA.
  
  
  RESULTS
  Among the 4.370 patients admitted, 23.3% died in the ICU. Mean (standard deviation) age was 56.8 (16.7) years, and median (first-third quartile) SAPS II was 48 (34-65). Areas under ROC curves were 0.828 (0.813-0.843) for SAPS II, 0.814 (0.798-0.829) for modified SAPS II and of 0.627 (0.608-0.646) for age. DCA showed a net benefit whatever the probability threshold, especially under 0.5.
  
  
  CONCLUSIONS
  DCA shows the benefits of the SAPS II to predict ICU mortality, especially when the probability threshold is low. Complementary studies are needed to define the exact role that the SAPS II can play in end-of-life decision-making in ICUs.
authors.affiliation: Intensive care unit, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allyn
authors.affiliation: Unité de Soutien Méthodologique, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France.|INSERM, CIC 1410, Saint-Pierre, Reunion Island, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Ferdynus
authors.affiliation: Department of Medical Information, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Bohrer
authors.affiliation: Unité de Soutien Méthodologique, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Dalban
authors.affiliation: Intensive care unit, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Valance
authors.affiliation: Intensive care unit, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Allou
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012372:ROC Curve; D012189:Retrospective Studies; D000072878:Simplified Acute Physiology Score