Validation of a prognostic score for mortality in elderly patients admitted to Intensive Care Unit
Luis Sanchez-Hurtado, Adrian Ángeles-Veléz, Brigette Tejeda-Huezo, Juan García-Cruz, Teresa Juárez-Cedillo
Keywords :
Elderly, Intensive Care Unit, mortality, prognostic scores, Simplified Acute Physiology Score 3
Citation Information :
Sanchez-Hurtado L, Ángeles-Veléz A, Tejeda-Huezo B, García-Cruz J, Juárez-Cedillo T. Validation of a prognostic score for mortality in elderly patients admitted to Intensive Care Unit. Indian J Crit Care Med 2016; 20 (12):695-700.
Context: The performance of a prognostic score must be evaluated prior to being used. The aim of the present study was to evaluate the predictive ability of hospital mortality of Simplified Acute Physiology Score 3 (SAPS 3) score in elderly patients admitted to Intensive Care Units (ICUs).
Aims: The aim of the present study was to evaluate the SAPS 3 score predictive ability of hospital mortality in elderly patients admitted to ICU.
Settings and Design: This study was conducted as a prospective cohort, in two mixed ICUs. Patients and Methods: Two hundred and eleven elderly patients were included.
Interventions: None. We compared the predictive accuracy of SAPS 3 measured at the first hour at ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) measured with the worst values in the first 24 h at ICU. The patients were followed until hospital discharge.
Statistical Analysis Used: Evaluation of discrimination through area under curve receiver operating characteristic (aROC) and calibration by Hosmer-Lemeshow (HL) test.
Results: The median age was 68 years. The hospital mortality rate was 35.54%. The mean value of SAPS 3 was 62.54 ± 12.51 and APACHE II was 17.46 ± 6.77. The mortality predicted by APACHE II was 24.98 ± 19.96 and for standard SAPS 3 equation 41.18 ± 22.34. The discrimination for SAPS 3 model was aROC = 0.68 (0.62-0.75) and to APACHE II aROC = 0.70 (0.63-0.78). Calibration: APACHE II with HL 10.127 P = 0.26, and standard SAPS 3 equation HL 7.204 P = 0.51. Conclusions: In this study, the prognostic model of SAPS 3 was not found to be accurate in predicting mortality in geriatric patients requiring ICU admission.
Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B. Should elderly patients be admitted to the Intensive Care Unit? Intensive Care Med 2007;33:1252-62.
Reinikainen M, Uusaro A, Niskanen M, Ruokonen E. Intensive care of the elderly in Finland. Acta Anaesthesiol Scand 2007;51:522-9.
Carson SS. The epidemiology of critical illness in the elderly. Crit Care Clin 2003;19:605-17, v.
Minne L, Ludikhuize J, de Jonge E, de Rooij S, Abu-Hanna A. Prognostic models for predicting mortality in elderly ICU patients: A systematic review. Intensive Care Med 2011;37:1258-68.
Minne L, Ludikhuize J, de Rooij SE, Abu-Hanna A. Characterizing predictive models of mortality for older adults and their validation for use in clinical practice. J Am Geriatr Soc 2011;59:1110-5.
Haq A, Patil S, Parcells AL, Chamberlain RS. The simplified acute physiology score III is superior to the simplified acute physiology score II and acute physiology and chronic health evaluation II in predicting surgical and ICU mortality in the "oldest old". Curr Gerontol Geriatr Res 2014;2014:934852.
López-Soto A, Sacanella E, Pérez Castejón JM, Nicolás JM. Elderly patient in an Intensive Critical Unit. Rev Esp Geriatr Gerontol 2009;44 Suppl 1:27-33.
Metnitz PG, Moreno RP, 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 1: Objectives, methods and cohort description. Intensive Care Med 2005;31:1336-44.
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;31:1345-55.
10 Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult Intensive Care Units. Crit Care Clin 2007;23:639-58.
Juarez-Cedillo T, Sanchez-Arenas R, Sanchez-Garcia S, Garcia-Peña C, Hsiung GY, Sepehry AA, et al. Prevalence of mild cognitive impairment and its subtypes in the Mexican population. Dement Geriatr Cogn Disord 2012;34:271-81.
Zilberberg MD, Shorr AF, Micek ST, Doherty JA, Kollef MH. Clostridium difficile-associated disease and mortality among the elderly critically ill. Crit Care Med 2009;37:2583-9.
de Rooij SE, Abu-Hanna A, Levi M, de Jonge E. Identification of high-risk subgroups in very elderly Intensive Care Unit patients. Crit Care 2007;11:R33.
Nannings B, Abu-Hanna A, de Jonge E. Applying PRIM (patient rule induction method) and logistic regression for selecting high-risk subgroups in very elderly ICU patients. Int J Med Inform 2008;77:272-9.
Torres OH, Francia E, Longobardi V, Gich I, Benito S, Ruiz D. Short- and long-term outcomes of older patients in Intermediate Care Units. Intensive Care Med 2006;32:1052-9.
Sikka P, Jaafar WM, Bozkanat E, El-Solh AA. A comparison of severity of illness scoring systems for elderly patients with severe pneumonia. Intensive Care Med 2000;26:1803-10.
Nierman DM, Schechter CB, Cannon LM, Meier DE. Outcome prediction model for very elderly critically ill patients. Crit Care Med 2001;29:1853-9.
Nassar AP, Malbouisson LM, Moreno R. Evaluation of simplified acute physiology score 3 performance: A systematic review of external validation studies. Crit Care 2014;18:R117.
Sakr Y, Krauss C, Amaral AC, Réa-Neto A, Specht M, Reinhart K, et al. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical Intensive Care Unit. Br J Anaesth 2008;101:798-803.
Silva Junior JM, Malbouisson LM, Nuevo HL, Barbosa LG, Marubayashi LY, Teixeira IC, et al. Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals. Rev Bras Anestesiol 2010;60:20-31.
Hernandez AM, Palo JE. Performance of the SAPS 3 admission score as a predictor of ICU mortality in a Philippine private tertiary medical center Intensive Care Unit. J Intensive Care 2014;2:29.
Qiao Q, Lu G, Li M, Shen Y, Xu D. Prediction of outcome in critically ill elderly patients using APACHE II and SOFA scores. J Int Med Res 2012;40:1114-21.
Zhu BP, Lemeshow S, Hosmer DW, Klar J, Avrunin J, Teres D. Factors affecting the performance of the models in the mortality probability model II system and strategies of customization: A simulation study. Crit Care Med 1996;24:57-63.