Scoring Systems for Comparison of Disease Severity in Intensive Care Unit Patients

Chapter 89 Scoring Systems for Comparison of Disease Severity in Intensive Care Unit Patients





Scores at ICU admission





4 How were scores assessing general severity at ICU admission constructed?


Scores were constructed in large, multicenter, prospective populations. The variables were selected and weighed by consensus of panels of experts (first version of SAPS in 1984, first version of APACHE in 1981, and APACHE II in 1985) or through multiple logistic regression analyses used for most recently developed scores (SAPS II and III, APACHE III and IV, and MPM II and III) to determine whether the parameters were independent predictors of hospital death. The tested variables include age, worst values over the first 24 hours of ICU admission for certain acute physiologic abnormalities (e.g., sodium, potassium, partial arterial oxygen tension, urine output, Glasgow Coma Scale), category at admission (medical or surgical patient), and several underlying diseases (e.g., metastatic cancer, acquired immunodeficiency syndrome). The MPM system also includes several therapeutic items (e.g., number of venous lines).


The SAPS III is based on a more complex methodology. It has the advantage of being based on a worldwide population and of giving a larger place to prior health status and to circumstances of admission in addition to the physiologic imbalance at ICU admission. MPM0, MPM III, and SAPS III are collected entirely at admission to the ICU (i.e., within 1 hour), which reduces potential suboptimal care in the first day of the ICU in the assessment of severity.


The most recent version of APACHE score is the APACHE IV developed in 2006 with use of a database of more than 100,000 patients admitted to 104 ICUs in 45 hospitals in the United States in 2002-2003, and remodeling the APACHE III score.


MPM III is a recent update of MPM0 (2007) with use of a database of 124,885 patients from 135 ICUs. This recent score uses 16 variables including three physiologic parameters obtained within 1 hour of ICU admission to estimate mortality probability at hospital discharge.




6 Which scores have been validated adequately?


The APACHE I and II, SAPS I, and MPM I have not been constructed or validated with the current accepted methodologic standards. The SAPS II, MPM II, and APACHE III scores have been shown to have good discrimination and calibration in large multicenter studies.


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Jul 6, 2016 | Posted by in CRITICAL CARE | Comments Off on Scoring Systems for Comparison of Disease Severity in Intensive Care Unit Patients

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