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

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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: χ2 = 7.10 with P = .525 for SAPS II and χ2 = 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.

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