SAPS 3 performance in cancer patients admitted to an intensive care unit in Brazil
Autor: L. Taniguchi, E. Siqueira
Intensive care unit, Hospital Sirio Libanes, Sao Paulo, Brazil
Correspondência: L. Taniguchi
Intensive Care Medicine Experimental 2019, 7(Suppl 3):001246
Simplified Acute Physiology Score 3 (SAPS 3) is the most accurate prognostic model for Brazil . However, recent evaluation of its performance in solid cancer patients has not been performed in our country.
To compare the performance of SAPS 3 in patients with and without solid cancer admitted to the intensive care unit (ICU) of a comprehensive oncological hospital in Brazil.
Retrospective cohort analysis of Epimed administrative database of adult patients (>18 years) first admission to the intensive care unit (ICU) of Hospital Sírio Libanês (São Paulo, Brazil) from 2012 to 2016. Patients were categorized according to the presence of solid cancer at ICU admission. Hematological patients were excluded. We evaluated discrimination using the area under the receiver operating characteristic curve (AUROC) and the agreement between observed and expected mortality rates (calibration) using the calibration belt.
We studied 7,390 patients (age 66.1±18.4 years, 54.1% male, SAPS 3 score 41.6± 13.3, 41.6% had cancer, 12.1% died during hospitalization). Cancer patients were younger compared to non-cancer patients (62.6±16.5 years vs 68.7±19.3 years respectively, p<0.001), had lower SAPS 3 (40.9±14 vs 42.1±12.8 respectively, p<0.001), were admitted more frequently after elective surgery (60.6% vs 24.9%, p<0.001), but had higher hospital mortality (14.1% vs 10.6%, p<0.001).
SAPS 3 discrimination was better for cancer patients (AUROC = 0.85) than for non-cancer patients (AUROC = 0.79) (p < 0.001). After we applied the calibration belt, we observed that in cancer patients the SAPS 3 match the average observed rates for the confidence level of 95%.
In noncancer patients the SAPS 3 overestimated mortality in those with low-middle risk (figure).
SAPS 3 has different performances in cancer and noncancer patients in our single-center cohort.
1. Moralez GM, Rabello LSCF, Lisboa TC, Lima MDFA, Hatum RM, De Marco FVC, et al. External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs. Ann Intensive Care. 2017;7:53.