ICU scoring systems: which one to use in oncology patients?

Introduction

The aim was to assess the performance of various ICU scoring systems in oncology patients.

Methods

A prospective analysis of data for all oncology patients admitted to the ICU over 6 months. For mortality prediction, SMR was computed. Calibration was assessed by Lemeshow-Hosmer goodness-of-fit test and discrimination by AUROC curves. Primary outcome was ICU mortality.

Results

ICU mortality was 36.5%. Mortality predicted by SAPS II score was closest to that of actual mortality with a SMR of 1.003, followed by that of MPM II0 (0.855) and APACHE II (1.181) scores (Table 1). SAPS II (X² = 1.842; P = 0.985) had the best calibration. Mechanical ventilation and use of vasopressors were significant baseline characteristics (Table 1). All of the scores tested had good efficacy but none reached statistical significance (Table 2).

Table 1 (abstract P503). AUC for predicting ICU mortality

Table 2 Baseline characteristics of survivors and nonsurvivors

Conclusions

The SAPS II and APACHE III scores showed good accuracy, calibration and mortality prediction. Nevertheless, the difference in efficacy was not statistically significant and the choice of scoring system may depend on the ease of use and local preferences.