• Ary Serpa Neto, AssunçãoMurillo Santucci Cesar deMSDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Andréia Pardini, and Eliézer Silva.
• Faculdade de Medicina do ABC, São Paulo, Brazil.
• Sao Paulo Med J. 2015 May 1; 133 (3): 199205199-205.

Context And ObjectivePrognostic models reflect the population characteristics of the countries from which they originate. Predictive models should be customized to fit the general population where they will be used. The aim here was to perform external validation on two predictive models and compare their performance in a mixed population of critically ill patients in Brazil.Design And SettingRetrospective study in a Brazilian general intensive care unit (ICU).MethodsThis was a retrospective review of all patients admitted to a 41-bed mixed ICU from August 2011 to September 2012. Calibration (assessed using the Hosmer-Lemeshow goodness-of-fit test) and discrimination (assessed using area under the curve) of APACHE II and SAPS III were compared. The standardized mortality ratio (SMR) was calculated by dividing the number of observed deaths by the number of expected deaths.ResultsA total of 3,333 ICU patients were enrolled. The Hosmer-Lemeshow goodness-of-fit test showed good calibration for all models in relation to hospital mortality. For in-hospital mortality there was a worse fit for APACHE II in clinical patients. Discrimination was better for SAPS III for in-ICU and in-hospital mortality (P = 0.042). The SMRs for the whole population were 0.27 (confidence interval [CI]: 0.23 - 0.33) for APACHE II and 0.28 (CI: 0.22 - 0.36) for SAPS III.ConclusionsIn this group of critically ill patients, SAPS III was a better prognostic score, with higher discrimination and calibration power.

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