[Comparison of simplified acute physiology score III and other scoring systems in prediction of 28-day prognosis in patients with severe sepsis].

OBJECTIVE: To investigate the power of the simplified acute physiology score III (SAPSIII) for prediction of outcome for patients with severe sepsis admitted to the intensive care unit (ICU).

METHODS: A retrospective study was conducted. 677 severe sepsis patients with age≥18 years old and the survival time in emergency ICU≥24 hours admitted to the emergency ICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2008 to December 2011 were enrolled. The acute physiology and chronic health evaluation II (APACHEII), sequential organ failure assessment (SOFA), SAPSII, SAPSIII, and mortality in emergency department sepsis (MEDS) scores were recorded based on the poorest value within 24 hours of ICU admission. The 28-day result as denoted as survival or death was considered as the end point of the study. The ability to predict mortality by the score systems was assessed by using receiver operating characteristic (ROC) curve analysis and binary logistic regression models.

RESULTS: Among the 677 patients with severe sepsis, 284 cases died within 28 days after admission, and the mortality rate was 41.9%. Compared with survivors, the patients in non-survival group was older with higher APACHEII, SOFA, SAPSII, SAPSIII, and MEDS scores and higher ratio of underlying diseases, such as primary hypertension and renal dysfunction, and they had more organ injury, higher ratio of lung infection and bacterial infection (P<0.05 or P<0.01). It was identified by logistic regression that the APACHEII, SOFA, SAPSII, SAPSIII and MEDS scores were significantly independent factors in 28-day death prediction in patients with severe sepsis (all P=0.000). The rank of areas under the ROC curve (AUC) from high to low were MEDS (0.970), APACHEII (0.893), SAPSIII (0.875), SOFA (0.871), and SAPSII (0.860), respectively. SAPSIII score and APACHEII, SOFA, SAPSII scores were found to have an equivalent capacity in predicting the prognosis (all P>0.05). The MEDS score in predicting the prognosis was obviously better than that of APACHEII, SOFA, SAPSII, and SAPSIII scores (all P<0.05 ). The MEDS score showed the best sensitivity (91.5%), and specificity (89.1%). The 28-day mortality in cases of MEDS≥11 was 85.8%.

CONCLUSIONS: (1) For patients with severe sepsis who were admitted to ICU, MEDS was superior to APACHEII, SOFA, SAPSII, and SAPSIII scores in predicting prognosis. MEDS≥11 may indicate a higher mortality rate. (2) SAPSIII score has comparable predictive capability with APACHEII, SOFA and SAPSII scores may be recommended for prediction of the prognosis of patients with severe sepsis in ICU. But the SAPSIII score is unsuitable for predicting the prognosis of patients with acute sepsis in ICU options, and it is not superior to that of SAPSIII score in predicting prognosis of patients with sepsis in the emergency ICU than other score systems.