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Assessment of the prognosis of coronary patients: performance and customization of generic severity indexes
X Sarmiento1, M Rué, J J Guardiola
1Intensive Care Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Insights
General severity scoring systems perform well in acute myocardial infarction patients. Customizing these models with fewer variables improves prognostic accuracy and simplifies calculations for better patient outcomes.
Area of Science:
- Critical Care Medicine
- Cardiology
- Health Services Research
Background:
- General severity scoring systems like APACHE II, SAPS II, and MPM II are used for critically ill patients.
- Their prognostic performance in specific cardiac conditions like acute myocardial infarction (AMI) requires evaluation.
- Existing models may benefit from customization to better suit coronary patient populations.
Purpose of the Study:
- To evaluate the prognostic accuracy of APACHE II, SAPS II, and MPM II in patients with AMI.
- To develop customized prognostic indexes for AMI patients using a reduced set of variables.
- To assess if customization enhances predictive performance and simplifies model application.
Main Methods:
- An inception cohort of 456 adult patients with AMI was studied in 17 ICUs.
- Performance of APACHE II, SAPS II, and MPM II was assessed using calibration and discrimination metrics.
- Logistic regression was employed to customize MPM II(24) and SAPS II, reducing variables.
Main Results:
- All general severity systems demonstrated adequate discrimination for AMI patients.
- MPM II(24) showed less satisfactory calibration compared to APACHE II and SAPS II.
- Customized MPM II(24 cor:) and SAPS II(cor:) models, each with five variables, exhibited improved calibration and discrimination over their original versions.
Conclusions:
- General prognostic indexes are effective for AMI patients but can be refined.
- Customization of severity scoring systems for AMI patients can reduce complexity.
- Reduced-variable customized models offer comparable or superior prognostic accuracy, enhancing clinical utility.
Study Objective:
To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables.
Design:
Inception cohort.
Setting:
Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands.
Patients:
Four hundred fifty-six patients with acute myocardial infarction.
Measurements And Results:
The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones.
Conclusions:
Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.