Key result
The SAPS II score effectively predicted 28-day mortality in ICU patients with acute pulmonary embolism, outperforming other scoring systems with an AUC of 0.835 (95% CI 0.801-0.870).
Why the study?
Acute pulmonary embolism is a life-threatening ICU emergency requiring effective risk assessment tools to improve patient outcomes, but the prognostic value of SAPS II for 28-day mortality needed evaluation.
Does the SAPS II score effectively predict 28-day mortality in ICU patients with acute pulmonary embolism compared to other scoring systems?
Cohort (n=1,031)
Yes
Does the SAPS II score effectively predict 28-day mortality in ICU patients with acute pulmonary embolism compared to other scoring systems?
Effect estimate: AUC 0.835 (95% CI 0.801-0.870)
p-value: p=<0.001
The SAPS II score is an effective tool for predicting 28-day mortality in ICU patients with acute pulmonary embolism, outperforming other common scoring systems.
SAPS II may aid 28-day mortality risk stratification in ICU PE; leaves open prospective validation against other scores.
BACKGROUND: Acute pulmonary embolism (APE) is a common and life-threatening emergency in intensive care units (ICUs). Effective risk assessment tools are essential to improve patient outcomes. This study aims to evaluate the association between Simplified Acute Physiology Score II (SAPS II) and 28-day mortality in ICU patients with APE. METHODS: We conducted a retrospective cohort study involving 1031 APE patients from the Multiparameter Intelligent Monitoring in Intensive Care Database IV (MIMIC-IV) databases (Derivation cohort, n = 745) and the Intensive Care Unit (ICU) of the First Affiliated Hospital of Dalian Medical University databases (External Validation cohort, n = 286) between 2008 and 2023. Our study collected 65 variables, including ICU-related clinical data and common scoring systems for response prognosis. First, we used the derived cohort to perform COX regression and random survival forest (RSF) to screen out important variables. Secondly, we evaluated the predictive value of the most important clinical variables. Finally, we further validated the results in an external validation cohort. RESULTS: A total of 259 people (25.1 %) died from all causes. We performed COX regression in the derived cohort and found that SAPII was associated with prognosis (p < 0.001). We used the RSF machine learning method to sort the importance of variables and found that SAPII score was the most important clinical variable. The restricted cubic splines (RCS) found that SAPII score was nonlinearly correlated with prognosis, and SAPII = 33 was the threshold associated with prognosis. SAPII score was the best compared with the other five scoring systems, and the AUC curve was 0.835 (95 %CI 0.801-0.870). We also found that SAPII score was the best in the validation cohort. CONCLUSION: SAPS II effectively predict 28-day mortality in ICU patients with APE, outperforming other commonly used scoring systems. It also provides practical thresholds for clinical risk stratification, which can enhance clinical decision-making and resource allocation in the ICU.
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Liu et al. (2025) conducted a cohort in acute pulmonary embolism (n=1,031). Simplified Acute Physiology Score II (SAPS II) vs. other scoring systems was evaluated on 28-day mortality (AUC 0.835, 95% CI 0.801-0.870, p=<0.001). The SAPS II score effectively predicted 28-day mortality in ICU patients with acute pulmonary embolism, outperforming other scoring systems with an AUC of 0.835 (95% CI 0.801-0.870).
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