• P G Metnitz, A Valentin, H Vesely, C Alberti, T Lang, K Lenz, H Steltzer, and M Hiesmayr.
• Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Austria. metnitz@akh-wien.ac.at
• Intensive Care Med. 1999 Feb 1;25(2):192-7.

ObjectivesTo evaluate the prognostic performance of the original Simplified Acute Physiology Score (SAPS) II in Austrian intensive care patients and to evaluate the impact of customization.DesignAnalysis of the database of a multicenter study.SettingNine adult medical, surgical, and mixed intensive care units (ICUs) in Austria.PatientsA total of 1733 patients consecutively admitted to the ICUs.Measurements And ResultsThe database included admission data, SAPS II, length of stay, and hospital mortality. The Hosmer-Lemeshow goodness-of-fit test for the SAPS II showed a lack of uniformity of fit (H = 89.1, 10 df, p < 0.0001; C = 91.8, 10 df, p < 0.0001). Subgroup analysis showed good performance in patients with cardiovascular (medical and surgical) diseases as the primary reasons for admission. A new predictive equation was derived by means of the logistic regression. Goodness-of-fit was excellent for the customized model (SAPS IIAM) (H = 11.2, 9 df, p = 0.33, C = 11.6, 9 df, p = 0.24). The mean standardized mortality ratio (SMR) changed from 0.81 +/- 0.26 to 0.93 +/- 0.29 with customization.ConclusionsSAPS II was not well calibrated when applied to all patients. However, it performed well for patients with cardiovascular diseases as the primary reason for admission and may thus be applied to these patients. Standardized mortality ratios that are calculated from scoring systems without known calibration must be viewed with skepticism.

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