Key result
The APACHE IV, SAPS III, MPM0 II, and ICMM scoring systems demonstrated moderate discrimination (AUCs 0.67-0.73) and good calibration, but none accurately discriminated survivors from nonsurvivors.
Why the study?
To evaluate and validate four severity-of-illness scores (APACHE IV, SAPS III, MPM0 II, and ICMM) in critically ill cancer patients.
Observational (n=431)
No
Four common severity-of-illness scores showed moderate discrimination and good calibration but could not accurately discriminate between survivors and nonsurvivors in critically ill cancer patients.
These scores warrant caution for mortality prediction in cancer ICU patients; larger prospective studies needed to improve discrimination.
Background and aims: To evaluate and validate four severity-of-illness scores, acute physiology and chronic health evaluation IV (APACHE IV), simplified acute physiology score III (SAPS III), mortality probability models II at 0 hours (MPM0 II), and ICU cancer mortality model (ICMM), in a prospective cohort of critically ill cancer patients. Materials and methods: Single-center, prospective observational study performed in a 14-bedded combined medical-surgical ICU of a tertiary care cancer center of India, from July 2014 to November 2015. Score performance was judged by discrimination and calibration, using the area under receiver-operating characteristics (ROC) curve and Hosmer-Lemeshow goodness-of-fit test, respectively. Results: A total of 431 patients were included in the study. Intensive care unit (ICU) and hospital mortality were 37.4% and 41.1%, respectively. The area under ROC curve for APACHE IV, SAPS III, MPM0 II, and ICMM were 0.73, 0.70, 0.67, and 0.67, respectively. Calibration as calculated by Hosmer-Lemeshow analysis type C statistics for APACHE IV, SAPS III, MPM0 II, and ICMM shows good calibration with Chi-square values of 5. 32, 9.285, 9.873, and 9.855 and p values of 0.723, 0.319, 0.274, and 0.275, respectively. Conclusion: All the four models had moderate discrimination and good calibration. However, none of the mortality prediction models could accurately discriminate between survivors and nonsurvivors in our patients.
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Siddiqui et al. (2019) conducted an observational in Critically ill cancer patients (n=431). APACHE IV, SAPS III, MPM0 II, and ICMM scoring systems was evaluated on Score performance judged by discrimination (area under ROC curve) and calibration for mortality. The APACHE IV, SAPS III, MPM0 II, and ICMM scoring systems demonstrated moderate discrimination (AUCs 0.67-0.73) and good calibration, but none accurately discriminated survivors from nonsurvivors.
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