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Validation of SAPS3 admission score and its customization for use in Korean intensive care unit patients: A prospective multicentre study

 So Yeon Lim  ;  Shin Ok Koh  ;  Kyeongman Jeon  ;  Sungwon Na  ;  Chae-Man Lim  ;  Won-Il Choi  ;  Young-Joo Lee  ;  Seok Chan Kim  ;  Gyu Rak Chon  ;  Je Hyeong Kim  ;  Jae Yeol Kim  ;  Jaemin Lim  ;  Chin Kook Rhee  ;  Sunghoon Park  ;  Ho Cheol Kim  ;  Jin Hwa Lee  ;  Ji Hyun Lee  ;  Jisook Park  ;  Younsuck Koh  ;  Gee Young Suh 
 RESPIROLOGY, Vol.18(6) : 989-995, 2013 
Journal Title
Issue Date
Aged ; Cohort Studies ; Critical Care* ; Female ; Hospital Mortality ; Hospitalization/statistics & numerical data* ; Humans ; Intensive Care Units ; Korea ; Male ; Middle Aged ; Models, Statistical ; Prognosis ; Prospective Studies ; Severity of Illness Index*
calibration ; discrimination ; intensive care unit ; severity of illness
BACKGROUND AND OBJECTIVE: To externally validate the simplified acute physiology score 3 (SAPS3) and to customize it for use in Korean intensive care unit (ICU) patients. METHODS: This is a prospective multicentre cohort study involving 22 ICUs from 15 centres throughout Korea. The study population comprised patients who were consecutively admitted to participating ICUs from 1 July 2010 to 31 January 2011. RESULTS: A total of 4617 patients were enrolled. ICU mortality was 14.3%, and hospital mortality was 20.6%. The patients were randomly assigned into one of two cohorts: a development (n = 2309) or validation (n = 2308) cohort. In the development cohort, the general SAPS3 had good discrimination (area under the receiver operating characteristics curve = 0.829), but poor calibration (Hosmer-Lemeshow goodness-of-fit test H = 123.06, P < 0.001, C = 118.45, P < 0.001). The Australasia SAPS3 did not improve calibration (H = 73.53, P < 0.001, C = 70.52, P < 0.001). Customization was achieved by altering the logit of the original SAPS3 equation. The new equation for Korean ICU patients was validated in the validation cohort, and demonstrated both good discrimination (area under the receiver operating characteristics curve = 0.835) and good calibration (H = 4.61, P = 0.799, C = 5.67, P = 0.684). CONCLUSIONS: General and regional Australasia SAPS3 admission scores showed poor calibration for use in Korean ICU patients, but the prognostic power of the SAPS3 was significantly improved by customization. Prediction models should be customized before being used to predict mortality in different regions of the world.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Koh, Shin Ok(고신옥)
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