The relationship of simplified acute physiology score 3 (SAPS 3) and C-reactive protein (CRP) levels with mortality rates and length of stay of patients in surgical intensive care unit

Objectives: The individual risk of surgical patients is more often underestimated and < 15% of patients whounderwent surgery were admitted to ICU. The prognostic scores were developed to assess the mortality rateand prognosis for critical patients including surgical ones. The Acute Physiology and Chronic Health Evaluation(APACHE) score and the Simplified Acute Physiology Score (SAPS) were most popular ones and they wererevised with the improvements in health care opportunities. As a prognostic scoring system SAPS 3’ resultswere defined as excellent in high risk surgical patient study group. CRP is useful as a prognostic indicator oran index of disease progression but its value has not been tested in acute settings adequately. The aim of thisstudy is to test the calibration power of SAPS 3 score and identify correlations between hospital mortality andpatient outcomes with SAPS 3 scores and CRP levels.Methods: This retrospective and analytical study was conducted one year period in surgical ICUs of tertiarylevel of attention in a public institution. It was a case–control medical record review and the patients includedin this study were those who admitted in the surgical ICU for any reason.Results: A total of 806 patients admitted to the Gastroenterological surgical ICU was included in the studybetween March 2016 and March 2017. The relation between mortality rate, length of stay in ICU and SAPS 3score was significant statistically and the relation of CRP levels with SAPS score and mortality rate was foundsignificant statistically.Conclusion: The discriminative power of SAPS 3 score was very good and the calibration was appropriate.

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[1] Caldeira VM, Silva Júnior JM, Oliveira AM, Rezende S, Araújo LA, Santana MR, et al. Criteria for patient admission to an intensive care unit and related mortality rates. Rev Assoc Med Bras (1992) 2010;56:528-34.
[2] Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilisation of critical care resources amongst highrisk surgical patients in a large NHS trust. Anaesthesia 2008;63:695-700.
[3] Bennett-Guerrero E, Hyam JA, Shaefi S, Prytherch DR, Sutton GL, Weaver PC, et al. Comparison of P-POSSUM risk adjusted mortality rates after surgery between patients in the USA and the UK. Br J Surg 2003;90:1593-8.
[4] Silva JM Jr, Rocha HMC, Katayama HT, Dias LF, de Paula MB, Andraus LMR, et al. SAPS 3 score as a predictive factor for postoperative referral to intensive care unit. Ann Intensive Care 2016;6:42.
[5] Sakr Y, Krauss C, Amaral A, Réa-Neto A, Specht M, Reinhart K, et al. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit. Br J Anaesth 2008;101:798-803.
[6] Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3--from evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005;31:1345-55.
[7] Silva Junior JM, Malbouisson LM, Nuevo HL, Barbosa LG, Marubayashi LY, Teixeira IC, et al. Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals. Rev Bras Anestesiol 2010;60:20-31.
[8] Evran T, Serin S, Gürses E, Sungurtekin H. Various scoring systems for predicting mortality in Intensive Care Unit. Niger J Clin Pract 2016;19:530-4.
[9] Ledoux D1, Canivet JL, Preiser JC, Lefrancq J, Damas P. SAPS 3 admission score: an external validation in a general intensive care population. Intensive Care Med 2008;34:1873-7.
[10] Chandrashekara S. C-reactive protein: an inflammatory marker with specific role in physiology, pathology, and diagnosis. IJRCI 2014;2(S1):SR3.
[11] Kaur M. C-reactive protein. A prognostic indicator. IJABMR 2017;7:83-4.
[12] Strand K, Flaatten H. Severity scoring in the ICU: a review. Acta Anaesthesiol Scand 2008;52:467-78.
[13] Kuzniewicz MW, Vasilevskis EE, Lane R, Dean ML, Trivedi NG, Rennie DJ, et al. Variation in ICU risk-adjusted mortality: impact of methods of assessment and potential confounders. Chest 2008;133:1319-27.
[14] Nassar APJ, Malbouisson LM, Moreno R. Evaluation of Simplified Acute Physiology Score 3 performance: a systematic review of external validation studies. Crit Care 2014;18:R117.
[15] Pieri G, Agarwal B, Burroughs AK. C-reactive protein and bacterial infection in cirrhosis. Ann Gastroenterol 2014;27:113- 20.