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VOLUME 28 , ISSUE 4 ( April, 2024 ) > List of Articles

Original Article

Comparative Predictive Accuracies of the Simplified Mortality Score for the Intensive Care Unit, Sepsis Severity Score, and Standard Severity Scores for 90-day Mortality in Sepsis Patients

Natthaka Sathaporn, Bodin Khwannimit

Keywords : Intensive care unit, Mortality, Risk prediction, Severity score

Citation Information : Sathaporn N, Khwannimit B. Comparative Predictive Accuracies of the Simplified Mortality Score for the Intensive Care Unit, Sepsis Severity Score, and Standard Severity Scores for 90-day Mortality in Sepsis Patients. Indian J Crit Care Med 2024; 28 (4):343-348.

DOI: 10.5005/jp-journals-10071-24673

License: CC BY-NC 4.0

Published Online: 30-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: The standard severity scores were used for predicting hospital mortality of intensive care unit (ICU) patients. Recently, the new predictive score, Simplified Mortality Score for the ICU (SMS–ICU), was developed for predicting 90-day mortality. Objective: To validate the ability of the SMS–ICU and compare with sepsis severity score (SSS) and original severity scores for predicting 90-day mortality in sepsis patients. Method: An analysis of retrospective data was conducted in the ICU of a university teaching hospital. Also, 90-day mortality was used for the primary outcome. Results: A total of 1,161 patients with sepsis were included. The 90-day mortality was 42.4%. The SMS–ICU presented the area under the receiver operating characteristic curve (AUROC) of 0.71, whereas the SSS had significantly higher AUROC than that of the SMS–ICU (AUROC 0.876, p < 0.001). The acute physiology and chronic health evaluation (APACHE) II and IV, and the simplified acute physiology scores (SAPS) II demonstrated good discrimination, with an AUROC above 0.90. The SMS–ICU provides poor calibration for 90-day mortality prediction, similar to the SSS and other standard severity scores. Furthermore, 90-day mortality was underestimated by the SMS–ICU, which had a standardized mortality ratio (SMR) of 1.36. The overall performance by Brier score demonstrated that the SMS–ICU was inferior to the SSS (0.222 and 0.169, respectively). Also, SAPS II presented the best overall performance with a Brier score of 0.092. Conclusion: The SMS–ICU indicated lower performance compared to the SSS, standard severity scores. Consequently, modifications are required to enhance the performance of the SMS–ICU.

Supplementary File


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  1. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362(9):779–789. DOI: 10.1056/NEJMoa0907118.
  2. Yang WS, Kang HD, Jung SK, Lee YJ, Oh SH, Kim YJ, et al. A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis-3). Clin Respir J 2020;14(9):857–863. DOI: 10.1111/crj.13218.
  3. Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019—results from a systematic review and meta-analysis. Crit Care 2020;24(1):239. DOI: 10.1186/s13054-020-02950-2.
  4. Le Gall JR. The use of severity scores in the intensive care unit. Intensive Care Med 2005;31(12):1618–1623. DOI: 10.1007/s00134-005-2825-8.
  5. Vincent JL, Moreno R. Clinical review: Scoring systems in the critically ill. Crit Care 2010;14(2):207. DOI: 10.1186/cc8204.
  6. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: A compendium. Indian J Crit Care Med 2014;18(4):220–228. DOI: 10.4103/0972-5229.130573.
  7. Breslow MJ, Badawi O. Severity scoring in the critically ill: Part 1 – Interpretation and accuracy of outcome prediction scoring systems. Chest 2012;141(1):245–252. DOI: 10.1378/chest.11-0330.
  8. Parajuli BD, Shrestha GS, Pradhan B, Amatya R. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality. Indian J Crit Care Med 2015;19(2):87–91. DOI: 10.4103/0972-5229.151016.
  9. Osborn TM, Phillips G, Lemeshow S, Townsend S, Schorr CA, Levy MM, et al. Sepsis severity score: An internationally derived scoring system from the surviving sepsis campaign database*. Crit Care Med 2014;42(9):1969–1976. DOI: 10.1097/CCM.0000000000 000416.
  10. Sathaporn N, Khwannimit B. Validation the performance of New York sepsis severity score compared with sepsis severity score in predicting hospital mortality among sepsis patients. J Crit Care 2019;53:155–161. DOI: 10.1016/j.jcrc.2019.06.017.
  11. Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: Propensity matched cohort study. BMJ 2016;353:i2375. DOI: 10.1136/bmj.i2375.
  12. Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA–ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol 2015;32(2):88–105. DOI: 10.1097/EJA.0000000000000118.
  13. Granholm A, Perner A, Krag M, Hjortrup PB, Haase N, Holst LB, et al. Development and internal validation of the simplified mortality score for the intensive care unit (SMS–ICU). Acta Anaesthesiol Scand 2018;62(3):336–346. DOI: 10.1111/aas.13048.
  14. Zampieri FG, Granholm A, Moller MH, Scotti AV, Alves A, Cabral MM, et al. Customization and external validation of the simplified mortality score for the intensive care unit (SMS–ICU) in Brazilian critically ill patients. J Crit Care 2020;59:94–100. DOI: 10.1016/j.jcrc.2020.05.016.
  15. Singer M, Deutschman CS, Seymour CW, Shankar–Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  16. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13(10):818–829. PMID: 3928249.
  17. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270(24):2957–2963. DOI: 10.1001/jama.270.24.2957.
  18. Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med 2011;39(1):163–169. DOI: 10.1097/CCM.0b013e3181f96f81.
  19. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148(3):839–843. DOI: 10.1148/radiology.148.3. 6878708.
  20. Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult intensive care units. Crit Care Clin 2007;23(3):639–658. DOI: 10.1016/j.ccc.2007.05.004.
  21. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics 1988;44(3):837–845. DOI: 10.2307/2531595.
  22. Harrison DA, Brady AR, Parry GJ, Carpenter JR, Rowan K. Recalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom. Crit Care Med 2006;34(5):1378–1388. DOI: 10.1097/01.CCM.0000216702.94014.75.
  23. Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005;31(10):1345–1355. DOI: 10.1007/s00134-005-2763-5.
  24. Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, et al. Assessing the performance of prediction models: A framework for traditional and novel measures. Epidemiology 2010;21(1):128–138. DOI: 10.1097/EDE.0b013e3181c30fb2.
  25. Chawla LS, Russell JA, Bagshaw SM, Shaw AD, Goldstein SL, Fink MP, et al. Angiotensin II for the Treatment of high-output shock 3 (ATHOS-3): Protocol for a phase III, double-blind, randomised controlled trial. Crit Care Resusc 2017;19(1):43–49. PMID: 28215131.
  26. Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med 2017;377(5):419–430. DOI: 10.1056/NEJMoa1704154.
  27. Benbenishty J, Weissman C, Sprung CL, Brodsky–Israeli M, Weiss Y. Characteristics of patients receiving vasopressors. Heart Lung 2011;40(3):247–252. DOI: 10.1016/j.hrtlng.2010.04.007.
  28. Jenkins CR, Gomersall CD, Leung P, Joynt GM. Outcome of patients receiving high dose vasopressor therapy: A retrospective cohort study. Anaesth Intensive Care 2009;37(2):286–289. DOI: 10.1177/0310057X0903700212.
  29. Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA 2012;307(23):2526–33. DOI: 10.1001/jama.2012.5669.
  30. Sakr Y, Francois B, Sole–Violan J, Kotfis K, Jaschinski U, Estella A, et al. Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: A comparison of two large cohorts. Crit Care 2021;25(1):87. DOI: 10.1186/s13054-020-03455-8.
  31. Villar J, Blanco J, del Campo R, Andaluz–Ojeda D, Diaz–Dominguez FJ, Muriel A, et al. Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome. BMJ Open 2015;5(3):e006812. DOI: 10.1136/bmjopen-2014-006812.
  32. Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care 2018;44:156–160. DOI: 10.1016/j.jcrc.2017.10.023.
  33. Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017;317(3):290–300. DOI: 10.1001/jama.2016.20328.
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