The predictive performance of the SAPS II and SAPS 3 scoring systems: A retrospective analysis

J Crit Care. 2016 Jun:33:180-5. doi: 10.1016/j.jcrc.2016.01.013. Epub 2016 Jan 13.

Abstract

Purpose: The purpose was to analyze and compare the performance of Simplified Acute Physiology Score (SAPS) II and SAPS 3 (North Europe Logit) in an intensive care unit (ICU) for internal disorders at a German university hospital.

Materials and methods: This retrospective study was conducted at a single-center 12-bed ICU sector for Internal Medicine in Essen, Germany, within an 18-month period. Data for adult ICU patients (N = 548) were evaluated. SAPS II and SAPS 3 scores were assessed along with the predicted mortality rates. Discrimination was evaluated by calculating the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit C-test. The ratios of observed-to-expected deaths (standardized mortality ratio, SMR) were calculated along with the 95% confidence intervals (95% CIs).

Results: The in-hospital mortality rate was 22.6%, which provided an SMR of 0.91 (95% CI, 0.77-0.99) for SAPS II and 0.62 (95% CI, 0.52-0.71) for SAPS 3. Both SAPS II and SAPS 3 exhibited acceptable discrimination, with an area under the receiver operating characteristic curve of 0.84 (95% CI, 0.79-0.89) and 0.73 (95% CI, 0.67-0.79), respectively. However, SAPS II demonstrated superior SMR-based discrimination, which was closer to the observed mortality rate, compared with SAPS 3. Calibration curves exhibited similar performance based on the Hosmer-Lemeshow goodness-of-fit C-test results: χ(2) = 7.10 with P = .525 for SAPS II and χ(2) = 3.10 with P = .876 for SAPS 3. Interestingly, both scores overpredicted mortality.

Conclusions: In this study, SAPS 3 overestimated mortality and therefore appears less suitable for risk evaluation in comparison to SAPS II.

Keywords: Critical care; ICU; Mortality; SAPS 3; SAPS II.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Care
  • Critical Illness / mortality*
  • Female
  • Germany
  • Hospital Mortality
  • Hospitals, University
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Simplified Acute Physiology Score*
  • Young Adult