• Fernando G Zampieri, Anders Granholm, Møller Morten Hylander MH Department of Intensive Care 4131, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Centre for Research in Intensive Care, , Alexandre Vaz Scotti, Alessandra Alves, Maurício Magalhães Cabral, Marcelo Ferreira Sousa, Henrique Miller Balieiro, Carlos Cesar Hortala, Filho Edison Moraes Rodrigues EMR ICU, Santa Casa de Porto Alegre - Hospital Dom Vicente Scherer, Porto Alegre, Brazil., Eric Perecmanis, Márcia Adélia de Magalhães Menezes, Carlos Eduardo Nassif Moreira, Giulliana Martines Moralez, Antônio Tonete Bafi, Clayton Barbieri de Carvalho, Salluh Jorge Ibrain Figueira JIF Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, Brazi, Fernando Augusto Bozza, Anders Perner, and Marcio Soares.
• Department of Critical Care, D'Or Institute for Research and Education, São Paulo, Brazil; Research Institute, HCor-Hospital do Coração, São Paulo, Brazil; Center for Epidemiological Research, University of Southern Denmark, Odense, Denmark. Electronic address: fzampieri@hcor.com.br.
• J Crit Care. 2020 Oct 1; 59: 94-100.

PurposeTo customize and externally validate the recently proposed Simplified Mortality Score for the ICU (SMS-ICU, a simple score for 90-day mortality that has no need for ancillary testing results) for in-hospital mortality and to compare its performance to SAPS 3.Material And MethodsWe used data from two distinct large cohorts of adult Brazilian patients with unplanned ICU admissions to perform a first-level customization (43,017 patients admitted to 78 ICUs) of the original SMS-ICU score for in-hospital mortality and, sequentially, externally validate it (313,365 patients admitted to 99 ICUs). Performance of SMS-ICU was assessed through measurements of discrimination and calibration and compared with SAPS 3.ResultsIn the validation cohort, median SMS-ICU was 13 (IQR 8-16) points and median SAPS 3 was 44 (IQR 36-51). Discrimination of SMS-ICU was good (AUC 0.817; 95% CI 0.814-0.819) but slightly lower than of SAPS 3 (AUC 0.845; 95% CI 0.843-0.848;). The customized SMS-ICU predictions were comparable to SAPS 3 in terms of calibration.ConclusionIn this external validation of the SMS-ICU in a large Brazilian cohort, we observed good discrimination of SMS-ICU and acceptable calibration after first-level customization. SMS-ICU can be used as a measure of illness severity for acutely admitted ICU patients in clinical studies.Copyright © 2020 Elsevier Inc. All rights reserved.

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