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Original Research: Critical Care |

Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and Influence of Resuscitation Status on Model PerformanceComparison of ICU Prognostic Models

Mark T. Keegan, MB; Ognjen Gajic, MD, FCCP; Bekele Afessa, MD, FCCP
Author and Funding Information

From the Division of Critical Care, Department of Anesthesiology (Dr Keegan), the Division of Pulmonary and Critical Care, Department of Medicine (Drs Gajic and Afessa), and the Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) group (Drs Keegan, Gajic, and Afessa), Mayo Clinic, Rochester, MN.

Correspondence to: Mark T. Keegan, MB, Mayo Clinic Department of Anesthesiology, Charlton 1145, 200 First St SW, Rochester, MN 55905; e-mail: keegan.mark@mayo.edu


Funding/Support: This research was funded by grants to Dr Keegan from the Mayo Clinic Rochester Critical Care Research Subcommittee and the Mayo Clinic Rochester Quality Innovation Program. This project was supported by the US National Institutes of Health/National Center for Research Resources Clinical and Translational Science Awards [Grant UL1 RR024150].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):851-858. doi:10.1378/chest.11-2164
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Background:  There are few comparisons among the most recent versions of the major adult ICU prognostic systems (APACHE [Acute Physiology and Chronic Health Evaluation] IV, Simplified Acute Physiology Score [SAPS] 3, Mortality Probability Model [MPM]0III). Only MPM0III includes resuscitation status as a predictor.

Methods:  We assessed the discrimination, calibration, and overall performance of the models in 2,596 patients in three ICUs at our tertiary referral center in 2006. For APACHE and SAPS, the analyses were repeated with and without inclusion of resuscitation status as a predictor variable.

Results:  Of the 2,596 patients studied, 283 (10.9%) died before hospital discharge. The areas under the curve (95% CI) of the models for prediction of hospital mortality were 0.868 (0.854-0.880), 0.861 (0.847-0.874), 0.801 (0.785-0.816), and 0.721 (0.704-0.738) for APACHE III, APACHE IV, SAPS 3, and MPM0III, respectively. The Hosmer-Lemeshow statistics for the models were 33.7, 31.0, 36.6, and 21.8 for APACHE III, APACHE IV, SAPS 3, and MPM0III, respectively. Each of the Hosmer-Lemeshow statistics generated P values < .05, indicating poor calibration. Brier scores for the models were 0.0771, 0.0749, 0.0890, and 0.0932, respectively. There were no significant differences between the discriminative ability or the calibration of APACHE or SAPS with and without “do not resuscitate” status.

Conclusions:  APACHE III and IV had similar discriminatory capability and both were better than SAPS 3, which was better than MPM0III. The calibrations of the models studied were poor. Overall, models with more predictor variables performed better than those with fewer. The addition of resuscitation status did not improve APACHE III or IV or SAPS 3 prediction.

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