Key result
Severity of illness models (APACHE III, MPM II, SAPS II) are excellent predictive tools for ICU populations, though they do not predict individual patient survival.
Severity of illness models like APACHE III, MPM II, and SAPS II are valuable for cohort-level outcome prediction and quality assurance in the ICU, though they cannot predict individual patient survival.
Comment: Discriminate Multivariate analysis is necessary to predict outcome in intensive care medicine. To perform such statistical analysis, it is necessary to have a large database of patients whose clinical course in the intensive care unit has been documented in a manner that allows inclusion of patients from many institutions in different environments. The authors of this landmark paper are leaders in the development of two of the severity systems (APACHE III and MPM II) used in intensive care databases. The Acute Physiology and Chronic Health Evaluation (APACHE III) was developed from the experience of ICU patients in the United States, whereas the Mortality Probability Models (MPM II) included patients from eleven countries as well as those from the United States. The Simplified Acute Physiology Score (SAPS II) is derived as a subset of variables from the APACHE III database. This paper concludes mat all three models prove to be excellent predictive tools in analyses used for therapeutic trials and a quality assurance tool for ICU performance. However, although scores predict the number of patients who will survive based on the worst values of several variables during the first 24, 48, or 72 hr in an ICU, they do not predict the likelihood of survival of individual patients with these derangements. It comes as no surprise that large databases (greater than 10,000 patients each) are accurate predictors of outcome in ICUs. The major value of this paper is the clear and concise description of how the current models have been developed, including their validation, calibration, and discrimination.
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Lemeshow et al. (1995) conducted a review in ICU patients. Severity of illness models (APACHE III, MPM II, SAPS II) was evaluated on Survival prediction. Severity of illness models (APACHE III, MPM II, SAPS II) are excellent predictive tools for ICU populations, though they do not predict individual patient survival.
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