Clinical outcome - PACT - ESICM

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Task 3. How to predict outcome p. 24The SAPS 3 Admission model was described in 2005 on adatabase where the SAPS II showed poor performance (seereferences below). It was developed on 16,784 patients admittedto 303 ICUs worldwide. This model takes into account threegroups of variables, named boxes. Box I (five variables)concerns patient characteristics and treatments before ICUadmission; box II (five variables) on circumstances related toICU admission and box III (ten physiological parameters)collected the hour before-after ICU admission. The SAPS 3Admission Score model allows computing of the probability ofhospital mortality by an ad hoc logit, but users can also adopt alogit specific for a geographical area (customisation). Thefollowing references may be useful.The SAPS 3AdmissionScore wasdeveloped withthe objective ofevaluating notonly individualpatient outcomebut also theeffectiveness ofICU practicesMetnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al; SAPS 3Investigators. SAPS 3 – From evaluation of the patient to evaluation of theintensive care unit. Part 1: Objectives, methods and cohort description.Intensive Care Med 2005; 31(10): 1336–1344. PMID 16132893. Full text(pdf)Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al; SAPS 3Investigators. SAPS 3 – From evaluation of the patient to evaluation of theintensive care unit. Part 2: Development of a prognostic model forhospital mortality at ICU admission. Intensive Care Med 2005; 31(10):1345–1355. Erratum in: Intensive Care Med 2006; 32(5): 796. PMID16132892. Full text (pdf)Capuzzo M, Moreno RP, Le Gall JR. Outcome prediction in critical care: theSimplified Acute Physiology Score models. Curr Opin Crit Care 2008;14(5): 485–490. Review. PMID 18787438A similar model targeting survival during the first 28 days after ICU admissionwas also described, based on the same database.Moreno R, Metnitz P, Jordan B, Einfalt JPB. SAPS 3 28 days score: a prognosticmodel to estimate patient survival during the first 28 days in the ICU[Abstract]. Intensive Care Med 2006; 32: S203.You can download a calculator for SAPS 3 Admission Score athttp://www.saps3.orgMortality Probability Models systemThe Mortality Probability Models (MPM) II were described in1993 to 1994 and were based on the same data as used for thedevelopment of SAPS II with additional data from six otherICUs in North America. In these models, the final result isexpressed only as a probability of death and not as a score. Themost recent MPM model (MPM 0-III) was published in 2009(see reference).The MPM IImodels weredeveloped to beapplied atadmission, andafter 24, 48 and72 hours in theICU
Task 3. How to predict outcome p. 25Higgins TL, Kramer AA, Nathanson BH, Copes W, Stark M, Teres D. Prospectivevalidation of the intensive care unit admission Mortality ProbabilityModel (MPM0-III). Crit Care Med 2009; 37(5):1619–1623. PMID19325480The MPM II models are defined according to the time frame considered:• The MPM II admission model (MPM II0), computed within one hourof ICU admission. This model contains 15 variables. It is the onlygeneral model that is independent of treatment provided in the ICUand therefore can be used for patient stratification at the time ofadmission to the ICU.• The MPM II 24 hour model (MPM II24), computed after 24 hours inthe ICU. This model comprises 13 variables.• The MPM II 48 hour model (MPM II48), computed after 48 hours inthe ICU.• The MPM II 72 hour model (MPM II72), computed after 72 hours inthe ICU.The MPM II48 and MPM II72 models use the same variables of the MPM II24model, with different weights for risk of death calculation. Both are based on theworst values presented by the patient during the previous 24 hours.The MPM 0-III (Higgins et al) is computed at ICU admission and contains 17variables. The development study has shown that the previous modelsignificantly over predicted mortality.Further details on the MPM models may be found in the online appendix andthe following references:Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. MortalityProbability Models (MPM II) based on an international cohort of intensivecare unit patients. JAMA 1993; 270(20): 2478–2486. PMID 8230626Lemeshow S, Klar J, Teres D, Avrunin JS, Gehlbach SH, Rapoport J, et al.Mortality probability models for patients in the intensive care unit for 48or 72 hours: a prospective, multicenter study. Crit Care Med 1994; 22(9):1351–1358 PMID 8062556Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M, Kramer AA. Assessingcontemporary intensive care unit outcome: an updated MortalityProbability Admission Model (MPM0–III). Crit Care Med 2007; 35(3):827–835. PMID 17255863Higgins TL, Teres D, Nathanson B. Outcome prediction in critical care: theMortality Probability Models. Curr Opin Crit Care 2008; 14(5): 498–505.Review. PMID 18787440You can find a calculator for MPM scores athttp://www.sfar.org/article/315/scores
Page 1 and 2: AN ESICM MULTIDISCIPLINARY DISTANCE
Page 3 and 4: LEARNING OBJECTIVESAfter studying t
Page 5 and 6: INTRODUCTIONOutcome refers to the r
Page 7 and 8: Task 1. How to define and appropria
Page 15 and 16: 2/ HOW TO MEASURE OUTCOMEThe measur
Page 17 and 18: Task 2. How to measure outcome p. 1
Page 23 and 24: heumatoid arthritis. In the critica
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Page 27: The latest version, APACHE IV, was
Page 41 and 42: eference helpful:Task 3. How to pre
Page 43 and 44: Task 4. How to measure and compare
Page 49 and 50: Conclusion p. 45CONCLUSIONIn the fi
Page 51 and 52: Self-assessment p. 479. Often repor
Page 53 and 54: Patient Challenges p. 49Activity da
Page 55 and 56: Patient Challenges p. 51Rotondi AJ,
Page 57 and 58: Vincent J-L, Rello J, Marshall J, S
Page 59 and 60: Patient Challenges p. 55Hibbert CL,
Page 61 and 62: Patient Challenges p. 57Finally the

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