title: Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients: Post-Hoc Analyses of the SUP-ICU Inception Cohort Study.
abstract: OBJECTIVE
  Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II and the initial SOFA score for in-hospital and 90-day mortality in a contemporary international cohort.
  
  
  METHODS
  This was a post-hoc study of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) inception cohort study, which included acutely ill adults from ICUs across 11 countries (n = 1034). We compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores. Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow's goodness-of-fit Ĉ-statistic.
  
  
  RESULTS
  AUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77-0.83) for SAPS II and 0.73 (95% CI 0.69-0.76) for initial SOFA score (P<0.001 for the comparison). Calibration of the customised SAPS II for predicting in-hospital mortality was adequate (P = 0.60). Discrimination of SAPS II was reduced compared with the original SAPS II validation sample (AUROC 0.80 vs. 0.86; P = 0.001). AUROC for 90-day mortality was 0.79 (95% CI 0.76-0.82; P = 0.74 for comparison with in-hospital mortality) for SAPS II and 0.71 (95% CI 0.68-0.75; P = 0.66 for comparison with in-hospital mortality) for the initial SOFA score.
  
  
  CONCLUSIONS
  The predictive performance of SAPS II was similar for in-hospital and 90-day mortality and superior to that of the initial SOFA score, but SAPS II's performance has decreased over time. Use of a contemporary severity score with improved predictive performance may be of value.
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
authors.forename: Anders
authors.identifier: http://orcid.org/0000-0001-5799-7655
authors.initials: A
authors.lastname: Granholm
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten Hylander
authors.initials: MH
authors.lastname: Møller
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Krag
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
authors.forename: Peter Buhl
authors.initials: PB
authors.lastname: Hjortrup
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009026:Mortality; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests