ICU severity of illness scores: APACHE, SAPS and MPM

Purpose of reviewThis review aims to evaluate the latest versions of the Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score and Mortality Probability Model scores, make comparisons and describe their strengths and limitations. Additionally, we provide critical analysis and recommendations for the use of these scoring systems in different scenarios. Recent findingsThe last generation of ICU scoring systems (Acute Physiology and Chronic Health Evaluation IV, Mortality Probability Model 0–III (MPM0-III) and Simplified Acute Physiology Score 3) was widely validated in different regions of the world and in distinct settings comprising general ICU patients as well as specific subgroups such as critically ill cancer patients, cardiovascular, surgical, acute kidney injury requiring renal replacement therapy and those in need of extra-corporeal membrane oxygen. Conflicting results are reported, and in general the scores presented a good discrimination despite a worse calibration as compared with the ones described in the original studies that generated them. Nonetheless, such calibration is often improved when customizations are performed both at ICU and region or country level. SummaryICU scoring systems provide a valuable framework to characterize patients’ severity of illness for the evaluation of ICU performance, for quality improvement initiatives and for benchmarking purposes. However, to ensure the best accuracy, constant updates as well as regional customizations are required.

[1]  S. Gautam,et al.  Performance of SAPS II and SAPS III scores in post-cardiac arrest. , 2012, Minerva anestesiologica.

[2]  W. Knaus,et al.  The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. , 1991, Chest.

[3]  H. Flaatten,et al.  A comparison of SAPS II and SAPS 3 in a Norwegian intensive care unit population , 2009, Acta anaesthesiologica Scandinavica.

[4]  R. Moreno.  Outcome prediction in intensive care: why we need to reinvent the wheel. , 2008, Current opinion in critical care.

[5]  J. Zimmerman,et al.  A history of outcome prediction in the ICU , 2014, Current opinion in critical care.

[6]  Hojoong Kim,et al.  Validation of the Simplified Acute Physiology Score 3 Scoring System in a Korean Intensive Care Unit , 2010, Yonsei medical journal.

[7]  Elisabeth Jouve,et al.  Effectiveness of SAPS III to predict hospital mortality for post-cardiac arrest patients. , 2014, Resuscitation.

[8]  Jenny Wong,et al.  Synthesis of the oxysterol, 24(S), 25-epoxycholesterol, parallels cholesterol production and may protect against cellular accumulation of newly-synthesized cholesterol , 2007, Lipids in Health and Disease.

[9]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[10]  M. Soares,et al.  SAPS 3 scores at the start of renal replacement therapy predict mortality in critically ill patients with acute kidney injury. , 2010, Kidney international.

[11]  Omar Badawi,et al.  Severity scoring in the critically ill: part 2: maximizing value from outcome prediction scoring systems. , 2012, Chest.

[12]  M. Keegan,et al.  Severity of illness scoring systems in the intensive care unit , 2011, Critical care medicine.

[13]  A. Muriel,et al.  Performance of the third-generation models of severity scoring systems (APACHE IV, SAPS 3 and MPM-III) in acute kidney injury critically ill patients. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[14]  H Pastides,et al.  A comparison of methods to predict mortality of intensive care unit patients , 1987, Critical care medicine.

[15]  J. M. Teles,et al.  Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study , 2010, Intensive Care Medicine.

[16]  J. L. Gall,et al.  A simplified acute physiology score for ICU patients , 1984, Critical care medicine.

[17]  A. P. N. Júnior,et al.  Aplicabilidade do escore fisiológico agudo simplificado (SAPS 3) em hospitais brasileiros , 2010 .

[18]  Peter Bauer,et al.  Austrian validation and customization of the SAPS 3 Admission Score , 2009, Intensive Care Medicine.

[19]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.

[20]  J. le Gall,et al.  Outcome prediction in critical care: the Simplified Acute Physiology Score models , 2008, Current opinion in critical care.

[21]  Nicola Latronico,et al.  External validation of the Simplified Acute Physiology Score (SAPS) 3 in a cohort of 28,357 patients from 147 Italian intensive care units , 2009, Intensive Care Medicine.

[22]  D. Teres,et al.  Assessing contemporary intensive care unit outcome: An updated Mortality Probability Admission Model (MPM0-III)* , 2007, Critical care medicine.

[23]  Chan-Yu Lin,et al.  Evaluation of outcome scoring systems for patients on extracorporeal membrane oxygenation. , 2007, The Annals of thoracic surgery.

[24]  J. Zimmerman,et al.  Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital mortality assessment for today’s critically ill patients* , 2006, Critical care medicine.

[25]  B. Khwannimit,et al.  A comparison of the performance of Simplified Acute Physiology Score 3 with old standard severity scores and customized scores in a mixed medical-coronary care unit. , 2011, Minerva anestesiologica.

[26]  M. Capuzzo,et al.  Validation of SAPS 3 Admission Score and comparison with SAPS II , 2009, Acta anaesthesiologica Scandinavica.

[27]  K. Wu,et al.  SAPS 3 at dialysis commencement is predictive of hospital mortality in patients supported by extracorporeal membrane oxygenation and acute dialysis. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[28]  A. Badreldin,et al.  SAPS 3 is not superior to SAPS 2 in cardiac surgery patients , 2014, Scandinavian cardiovascular journal : SCJ.

[29]  Yen-Hung Lin,et al.  Patients supported by extracorporeal membrane oxygenation and acute dialysis: acute physiology and chronic health evaluation score in predicting hospital mortality. , 2010, Artificial organs.

[30]  Jean-Charles Preiser,et al.  SAPS 3 admission score: an external validation in a general intensive care population , 2008, Intensive Care Medicine.

[31]  F. Guillén-Grima,et al.  Performance of SAPS3, compared with APACHE II and SOFA, to predict hospital mortality in a general ICU in Southern Europe , 2009, European journal of anaesthesiology.

[32]  Nicola Latronico,et al.  Comparison between SAPS II and SAPS 3 in predicting hospital mortality in a cohort of 103 Italian ICUs. Is new always better? , 2012, Intensive Care Medicine.

[33]  Kathryn M Rowan,et al.  Outcome prediction in critical care: the ICNARC model , 2008, Current opinion in critical care.

[34]  B. Woodford,et al.  Predictive Performance of Acute Physiological and Chronic Health Evaluation Releases II to IV: A Single New Zealand Centre Experience , 2012, Anaesthesia and intensive care.

[35]  Antonio Paulo Nassar,et al.  Caution when using prognostic models: a prospective comparison of 3 recent prognostic models. , 2012, Journal of critical care.

[36]  E. Draper,et al.  APACHE II: A severity of disease classification system , 1985, Critical care medicine.

[37]  M. Soares,et al.  Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care , 2006, Intensive Care Medicine.

[38]  Peter Bauer,et al.  Variability in outcome and resource use in intensive care units , 2007, Intensive Care Medicine.

[39]  B. Khwannimit,et al.  The performance and customization of SAPS 3 admission score in a Thai medical intensive care unit , 2010, Intensive Care Medicine.

[40]  J. Vincent,et al.  Clinical review: Scoring systems in the critically ill , 2010, Critical care.

[41]  Benjamin J. Turk,et al.  An Electronic Simplified Acute Physiology Score-Based Risk Adjustment Score for Critical Illness in an Integrated Healthcare System* , 2013, Critical care medicine.

[42]  S. Lemeshow,et al.  Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. , 1993, JAMA.

[43]  Mitzi L. Dean,et al.  Variation in ICU risk-adjusted mortality: impact of methods of assessment and potential confounders. , 2008, Chest.

[44]  Omar Badawi,et al.  Severity scoring in the critically ill: part 1--interpretation and accuracy of outcome prediction scoring systems. , 2012, Chest.

[45]  S. Vieira,et al.  Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients? , 2013, Clinics.

[46]  A. Mocelin,et al.  SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units? , 2013, Sao Paulo medical journal = Revista paulista de medicina.

[47]  D. Teres,et al.  Prospective validation of the intensive care unit admission Mortality Probability Model (MPM0-III)* , 2009, Critical care medicine.

[48]  R. Dang,et al.  Comparison of newer scoring systems with the conventional scoring systems in general intensive care population. , 2012, Minerva anestesiologica.

[49]  N. D. de Keizer,et al.  External validation of Acute Physiology and Chronic Health Evaluation IV in Dutch intensive care units and comparison with Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II. , 2011, Journal of critical care.

[50]  M. Carmona,et al.  Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals. , 2010, Revista brasileira de anestesiologia.

[51]  H. Flaatten,et al.  The interrater reliability of SAPS II and SAPS 3 , 2010, Intensive Care Medicine.

[52]  K. Polderman,et al.  Inter-observer variability in APACHE II scoring: effect of strict guidelines and training , 2001, Intensive Care Medicine.