SAPS 3-From evaluation of the patient to evaluation of the intensive care unit. Part 1. Objectives, methods and cohort description

• Published in: Intensive care medicine 2005-10, Vol.31 (10), p.1336-1344
• Main Authors: METNITZ, Philipp G. H, MORENO, Rui P, ALMEIDA, Eduardo, JORDAN, Barbara, BAUER, Peter, CAMPOS, Ricardo Abizanda, IAPICHINO, Gaetano, EDBROOKE, David, CAPUZZO, Maurizia, LE GALL, Jean-Roger
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Capitation; Clinical death. Palliative care. Organ gift and preservation; Critically ill; Data Collection; Evaluation Studies as Topic; Female; Hospital Mortality; Humans; Intensive care; Intensive care medicine; Intensive care nursing; Intensive care units; Intensive Care Units - statistics & numerical data; Investigative techniques, diagnostic techniques (general aspects); Length of Stay; Male; Medical sciences; Methods; Middle Aged; Mortality; Original; Patient outcomes; Patients; Physiology; Prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Risk assessment; Risk Factors; Severity of Illness Index
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-005-2762-6

Risk adjustment systems now in use were developed more than a decade ago and lack prognostic performance. Objective of the SAPS 3 study was to collect data about risk factors and outcomes in a heterogeneous cohort of intensive care unit (ICU) patients, in order to develop a new, improved model for risk adjustment. Prospective multicentre, multinational cohort study. A total of 19,577 patients consecutively admitted to 307 ICUs from 14 October to 15 December 2002. Data were collected at ICU admission, on days 1, 2 and 3, and the last day of the ICU stay. Data included sociodemographics, chronic conditions, diagnostic information, physiological derangement at ICU admission, number and severity of organ dysfunctions, length of ICU and hospital stay, and vital status at ICU and hospital discharge. Data reliability was tested with use of kappa statistics and intraclass-correlation coefficients, which were >0.85 for the majority of variables. Completeness of the data was also satisfactory, with 1 [0-3] SAPS II parameter missing per patient. Prognostic performance of the SAPS II was poor, with significant differences between observed and expected mortality rates for the overall cohort and four (of seven) defined regions, and poor calibration for most tested subgroups. The SAPS 3 study was able to provide a high-quality multinational database, reflecting heterogeneity of current ICU case-mix and typology. The poor performance of SAPS II in this cohort underscores the need for development of a new risk adjustment system for critically ill patients.