Topic
SAPS II
About: SAPS II is a research topic. Over the lifetime, 1038 publications have been published within this topic receiving 58193 citations. The topic is also known as: Simplified Acute Physiology Score.
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TL;DR: The form and validation results of APACHE II, a severity of disease classification system that uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status, are presented.
Abstract: This paper presents the form and validation results of APACHE II, a severity of disease classification system. APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease. An increasing score (range 0 to 71) was closely correlated with the subsequent risk of hospital death for 5815 intensive care admissions from 13 hospitals. This relationship was also found for many common diseases. When APACHE II scores are combined with an accurate description of disease, they can prognostically stratify acutely ill patients and assist investigators comparing the success of new or differing forms of therapy. This scoring index can be used to evaluate the use of hospital resources and compare the efficacy of intensive care in different hospitals or over time.
14,583 citations
TL;DR: The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis, and is a starting point for future evaluation of the efficiency of intensive care units.
Abstract: Objective. —To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method to convert the score to a probability of hospital mortality. Design and Setting. —The SAPS II and the probability of hospital mortality were developed and validated using data from consecutive admissions to 137 adult medical and/or surgical intensive care units in 12 countries. Patients. —The 13 152 patients were randomly divided into developmental (65%) and validation (35%) samples. Patients younger than 18 years, burn patients, coronary care patients, and cardiac surgery patients were excluded. Outcome Measure. —Vital status at hospital discharge. Results. —The SAPS II includes only 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Goodness-of-fit tests indicated that the model performed well in the developmental sample and validated well in an independent sample of patients (P=.883 andP=.104 in the developmental and validation samples, respectively). The area under the receiver operating characteristic curve was 0.88 in the developmental sample and 0.86 in the validation sample. Conclusion. —The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis. This is a starting point for future evaluation of the efficiency of intensive care units. (JAMA. 1993;270:2957-2963)
5,836 citations
TL;DR: The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h ofICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed.
3,693 citations
TL;DR: In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality, and among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay.
Abstract: Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40% to 65%. The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients. The data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. All adult patients admitted to a participating ICU between 1 and 15 May 2002, except those admitted for uncomplicated postoperative surveillance, were eligible for the study. For the purposes of this substudy, patients were divided into two groups according to whether they had ARF. The groups were compared with respect to patient characteristics, fluid balance, and outcome. Of the 3,147 patients included in the SOAP study, 1,120 (36%) had ARF at some point during their ICU stay. Sixty-day mortality rates were 36% in patients with ARF and 16% in patients without ARF (P < 0.01). Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41% versus 33% and 52% versus 32%, respectively; P < 0.01). Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score II (SAPS II), heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation. Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay. In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.
820 citations
TL;DR: The TNF2 allele is strongly associated with susceptibility to septic shock and death due to sepsis and the level of corresponding TNF-alpha concentrations.
Abstract: ContextTumor necrosis factor alpha (TNF-α) is believed to be a cytokine
central to pathogenesis of septic shock. TNF2, a
polymorphism within the TNF-α gene promoter, has been associated with
enhanced TNF-α production and negative outcome in some severe infections.ObjectivesTo investigate the frequency of the TNF2 allele
in patients with septic shock and to determine whether the allele is associated
with the occurrence and outcome of septic shock.DesignMulticenter case-control study conducted from March 1996 to June 1997.SettingSeven medical intensive care units in university hospitals.SubjectsEighty-nine patients with septic shock and 87 healthy unrelated blood
donors.Main Outcome MeasuresFrequency of the TNF2 allele among patients
with septic shock and among those who died and the level of corresponding
TNF-α concentrations.ResultsMortality among patients with septic shock was 54%, consistent with
the predicted mortality from the Simplified Acute Physiologic Score (SAPS
II) value. The polymorphism frequencies of the controls and the patients with
septic shock differed only at the TNF2 allele (39%
vs 18% in the septic shock and control groups, respectively, P=.002). Among the septic shock patients, TNF2
polymorphism frequency was significantly greater among those who had died
(52% vs 24% in the survival group, P=.008). Concentrations
of TNF-α were higher in 68% and 52% with the TNF2 and TNF1 polymorphisms, respectively, but
their median values (48 pg/mL vs 29 pg/mL) were not statistically different
(P = .31). After controlling for age and the probability
of death, derived by the SAPS II score, multiple logistic regression analysis
showed that, for the same rank of SAPS II value, patients with the TNF2 allele had a 3.7-fold risk of death (95% confidence interval,
1.37-10.24).ConclusionThe TNF2 allele is strongly associated with
susceptibility to septic shock and death due to septic shock.
745 citations