Abstract

Background

The aim of the study was to evaluate the performance of “Acute Physiology and Chronic Health Evaluation II” (APACHE-II), “Simplified Acute Physiology Score 3” (SAPS-3), and “APACHE-II Score for Critically Ill Patients with a Solid Tumor” (APACHE-II_CCP) models in cancer patients admitted to ICU.

Methods

Prospective cohort study of 414 patients with an active solid tumor. Discrimination was assessed by area under receiver operating characteristic (AROC) curves and calibration by Hosmer–Lemeshow goodness-of-fit C test (H–L).

Results

The hospital mortality rate was 32.6%. In the total cohort, discrimination for prognostic models were: APACHE-II_CCP (AROC 0.98), APACHE-II (AROC 0.96), SAPS-3 for Central and South American countries (SAPS-3_CSA) (AROC 0.95), and SAPS-3 (AROC 0.91). Calibration was good (p value of H–L test > 0.05) using APACHE-II_CCP, APACHE-II and SAPS-3_CSA models. Estimation of the probability of death was more precise with APACHE-II_CCP (standardized mortality ratio, SMR = 1.03) and SAPS-3 (SMR = 1.08) models. Further analysis showed that discrimination was high with all prognostic model whether for patients with planned ICU admission (AROC APACHE-II_CCP 0.97, APACHE-II 0.96, SAPS-3 0.95, SAPS-3_CSA 0.95) or for patients with unplanned ICU admission (AROC APACHE-II_CCP 0.97, APACHE-II 0.94, SAPS-3 0.86, SAPS-3_CSA 0.95). Calibration was good for all predictive models in both subgroups (p value of H–L test > 0.05, except for APACHE-II model inpatients with planned ICU admission).

Conclusions

In this prospective study, general predictive models (e.g., APACHE-II, SAPS-3) and cancer-specific models (e.g., APACHE-II_CCP) are accurate in predicting hospital mortality. Other studies confirming these results are required.

中文翻译：

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三种预后模型在危重症癌症患者中的表现：一项前瞻性研究。

摘要

背景

该研究的目的是评估“重症生理和慢性健康评估II”（APACHE-II），“简化的急性生理学评分3”（SAPS-3）和“ APACHE-II评分”对重症患者的治疗效果。接受ICU治疗的癌症患者的实体瘤”（APACHE-II _CCP）模型。

方法

414名活动性实体瘤患者的前瞻性队列研究。通过接收器工作特性（AROC）曲线下的面积评估歧视，并通过Hosmer–Lemeshow拟合优度C检验（H–L）进行校准。

结果

医院死亡率为32.6％。在总体队列中，对预后模型的区分是：APACHE-II _CCP（AROC 0.98），APACHE-II（AROC 0.96），中美洲和南美国家的SAPS-3（SAPS-3 _CSA）（AROC 0.95）和SAPS -3（AROC 0.91）。使用APACHE-II _CCP，APACHE-II和SAPS-3 _CSA模型的校准很好（H–L测试的p值> 0.05）。使用APACHE-II _CCP（标准死亡率，SMR = 1.03）和SAPS-3（SMR = 1.08）模型可以更精确地估计死亡可能性。进一步的分析表明，对于所有计划内ICU入院的患者，所有预后模型均存在较高的歧视性（AROC APACHE-II _CCP0.97，APACHE-II 0.96，SAPS-3 0.95，SAPS-3 _CSA 0.95）或计划外ICU入院的患者（AROC APACHE-II _CCP 0.97，APACHE-II 0.94，SAPS-3 0.86，SAPS-3 _CSA 0.95）。在两个亚组中，所有预测模型的校正都很好（H-L检验的p值> 0.05，但计划入住ICU的APACHE-II模型住院患者除外）。

结论

在这项前瞻性研究中，一般预测模型（例如APACHE-II，SAPS-3）和癌症特定模型（例如APACHE-II _CCP）在预测医院死亡率方面是准确的。还需要其他研究来证实这些结果。