Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000100003
Brazilian Journal of Anesthesiology
Scientific Article

Aplicabilidade do escore fisiológico agudo simplificado (SAPS 3) em hospitais brasileiros

Applicability of the simplified acute physiology score (SAPS 3) in brazilian hospitals

João Manoel Silva Junior; Luiz M Sá Malbouisson; Hector L Nuevo; Luiz Gustavo T Barbosa; Lauro Yoiti Marubayashi; Isabel Cristina Teixeira; Antonio Paulo Nassar Junior; Maria Jose Carvalho Carmona; Israel Ferreira da Silva; José Otávio Costa Auler Júnior; Ederlon Rezende

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Resumo

JUSTIFICATIVA E OBJETIVOS: O sistema prognóstico SAPS 3 (Simplified Acute Physiology Score 3) é composto de 20 variáveis, representadas por escore fisiológico agudo e avaliação do estado prévio, visando estabelecer índice preditivo de mortalidade para pacientes admitidos em unidades de terapia intensiva (UTI). O estudo teve objetivo de validar este sistema e verificar o poder discriminatório deste índice em pacientes cirúrgicos do Brasil. MÉTODO: Estudo prospectivo, realizado em duas UTI especializadas em pacientes cirúrgicos de dois diferentes hospitais, no período de um ano, excluiuse pacientes com idade inferior a 16 anos, que permaneceram tempo inferior a 24 horas na UTI, readmitidos e aqueles admitidos para procedimento dialítico. A habilidade preditiva do índice SAPS 3 em diferenciar sobreviventes e não sobreviventes foi verificada utilizando curva ROC e a calibração pelo teste Hosmer-Lemeshow goodness-of-fit. RESULTADOS: Foram incluídos no estudo 1.310 pacientes. Operações gastrintestinais foram predominantes (34,9%). O menor valor do índice SAPS 3 foi 18 e o maior 154, média de 48,5 ± 18,1. A mortalidade hospitalar prevista e real foi de 10,3% e de 10,8%, respectivamente, razão de mortalidade padronizada (SMR) foi 1,04 (IC95% = 1,03-1,07). A calibração pelo método Hosmer e Lemeshow mostrou X² = 10,47 p = 0,234. O valor do escore SAPS 3 que melhor discriminou sobreviventes e não sobreviventes foi 57, com sensibilidade de 75,8% e especificidade de 86%. Dos pacientes com índice SAPS 3 maior que 57, 73,5% não sobreviveram versus 26,5% de sobreviventes (OR = 1,32 IC95% 1,23 - 1,42, p < 0,0001). CONCLUSÕES: O sistema SAPS 3 é válido na população brasileira de pacientes cirúrgicos, sendo útil para indicar pacientes graves e determinar maiores cuidados neste grupo.

Palavras-chave

MORTALIDADE, Hospitalar, TERAPIA INTENSIVA

Abstract

BACKGROUND AND OBJECTIVES: The SAPS 3 (Simplified Acute Physiology Score 3) prognostic system is composed of 20 parameters, represented by an acute physiology score and assessment of the previous status, aimed at establishing a predictive mortality index for patients admitted to intensive care units (ICU). The objective of this study was to validate this system and determine its discriminatory power in surgical patients in Brazil. METHODS: This is a prospective study undertaken in two surgical ICUs of two different hospitals over a one-year period; patients younger than 16 years, who stay at the ICU for less than 24 hours, readmitted to the unit, and those admitted for dialysis were excluded from the study. The predictive ability of the SAPS 3 index to differentiate survivors and non-survivors was determined by the ROC curve and calibration by the Hosmer-Lemeshow goodness-of-fit test. RESULTS: One thousand three-hundred and ten patients were included in the study. Gastrointestinal surgeries predominated (34.9%). Eighteen was the lower SAPS 3 index and the highest was 154, with a mean of 48.5 ± 18.1. The predicted and real hospital mortality was 10.3% and 10.8%, respectively; the standardized mortality ratio (SMR) was 1.04 (95%CI = 1.03-1.07). Calibration by the Hosmer and Lemeshow method showed X² = 10.47 p = 0.234. The SAPS 3 score that better discriminated survivors and non-survivors was 57, with sensitivity of 75.8% and specificity 86%. Among the patients with SAPS 3 index higher than 57, 73.5% did not survive versus 26.5% who survived (OR= 1.32, 95%CI 1.23-1.42, p < 0.0001). CONCLUSIONS: The SAPS 3 system is valid for the Brazilian population of surgical patients, being a useful indicator of critical patients and to determine greater care in this group.

Keywords

INTENSIVE CARE, MORTALITY, Hospital

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