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Austrian validation and customization of the SAPS 3 Admission Score

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Abstract

Objective

To test the prognostic performance of the SAPS 3 Admission Score in a regional cohort and to empirically test the need and feasibility of regional customization.

Design

Prospective multicenter cohort study.

Patients and setting

Data on a total of 2,060 patients consecutively admitted to 22 intensive care units in Austria from October 2, 2006 to February 28, 2007.

Measurements and results

The database includes basic variables, SAPS 3, length-of-stay and outcome data. The original SAPS 3 Admission Score overestimated hospital mortality in Austrian intensive care patients through all strata of the severity-of-illness. This was true for both available equations, the General and the Central and Western Europe equation. For this reason a customized country-specific model was developed, using cross-validation techniques. This model showed excellent calibration and discrimination in the whole cohort (Hosmer–Lemeshow goodness-of-fit: Ĥ = 4.50, P = 0.922; Ĉ = 5.61, P = 0.847, aROC, 0.82) as well as in the various tested subgroups.

Conclusions

The SAPS 3 Admission Score’s general equation can be seen as a framework for addressing the problem of outcome prediction in the general population of adult ICU patients. For benchmarking purposes, region-specific or country-specific equations seem to be necessary in order to compare ICUs on a similar level.

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Acknowledgments

We thank the members of the ASDI study group and their respective study co-ordinators in each ICU: Günter Sagmüller, UKH Meidling, Vienna; Franz Schwameis, Landesklinikum Thermenregion Baden, Baden; Brigitte Pichler, Landesklinikum Weinviertel Mistelbach/Gänserndorf, Mistelbach; Felix Ernst, Landesklinikum Weinviertel Mistelbach/Gänserndorf, Mistelbach; Thomas Bauer, Landesklinikum Krems, Krems A. D. Donau; Franz Sterrer, A. ö. LKH Vöcklabruck, Vöcklabruck; Helmut Trimmel, A. ö. KH Wiener Neustadt, Wiener Neustadt; Walter Klimscha, Donauspital SMZ Ost, Vienna; Dieter Linemayr, Landesklinikum Mödling, Mödling; Johannes Schuh, A. ö. KH Wiener Neustadt, Wiener Neustadt; Gabriele Sprinzl, Landesklinikum Donauregion Tulln, Tulln; Kurt Dörre, A. ö. KH Waidhofen a.d. Thaya, Waidhofen A. D. Thaya; Helmut Trimmel, A. ö. KH Wiener Neustadt, Wiener Neustadt; Günther Frank, A. ö. KH der Barmherzigen Brüder Eisenstadt, Eisenstadt; Heinz Malle, UKH Klagenfurt, Klagenfurt; Ingrid Schindler, Sozialmedizinisches Zentrum Floridsdorf, Vienna; Sylvia Fitzal, Wilhelminenspital der Stadt Wien, Vienna; Reinhard Schuster, Donauspital SMZ Ost, Vienna; Gottfried Locker, AKH Wien Universitätskliniken, Vienna; Helmut Schneller, A. ö. KH der Barmherzigen Brüder Linz, Linz; Hubert Artmann, Kardinal Schwarzenberg’sches Krankenhaus, Schwarzach/Pongau; Oswald Schuberth, A. ö. LKH Steyr, Steyr; Statistical analysis was supported by a grant from the Fund of the Austrian National Bank, Project # 12690 ONB.

Conflict of interest statement

The authors declare that there exist no financial or other conflicts of interest. None of the authors has recently been employed or received reimbursements, fees, funding, or salary by/from an organization that may in any way gain or lose financially from the publication of this manuscript. No author holds any stocks or shares or patents in/from an organization that may in any way gain or lose financially from the publication of this manuscript.

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Authors and Affiliations

  1. Department of Medical Statistics, Medical University of Vienna, Vienna, Austria

    Barbara Metnitz & Peter Bauer

  2. Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria

    Eva Schaden & Philipp G. H. Metnitz

  3. Unidade de Cuidados Intensivos Polivalente, Hospital de St António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Al. de St António dos Capuchos, Lisbon, Portugal

    Rui Moreno

  4. Dept. Réanimation Médicale, Hôpital St Louis, Université Paris VII, Paris, France

    Jean-Roger Le Gall

Authors
  1. Barbara Metnitz
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  2. Eva Schaden
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  3. Rui Moreno
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  4. Jean-Roger Le Gall
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  5. Peter Bauer
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  6. Philipp G. H. Metnitz
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on behalf of the ASDI Study Group

Corresponding author

Correspondence to Philipp G. H. Metnitz.

Additional information

Philipp G. H. Metnitz, Rui Moreno, Peter Bauer, Barbara Metnitz and Jean-Roger Le Gall are all authors of the main SAPS 3 report [4, 5].

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Metnitz, B., Schaden, E., Moreno, R. et al. Austrian validation and customization of the SAPS 3 Admission Score. Intensive Care Med 35, 616–622 (2009). https://doi.org/10.1007/s00134-008-1286-2

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