Performance in mortality prediction of SAPS 3 And MPM0-III scores among adult patients admitted to the ICU of a private tertiary referral hospital in Tanzania: A single center retrospective cohort study

Nadeem Kassam

Date of Award

2021

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Eric Aghan

Second Supervisor/Advisor

Dr. Samina Somji

Third Supervisor/Advisor

Mr. James Orwa

Department

Medical College (East Africa)

Abstract

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the intensive care unit. They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified acute physiology score (SAPS 3) and Mortality probability models (MPM0-III) in predicting ICU outcome as well as identified disease pattern and clinical factors associated with increased mortality.

Methods. This was a retrospective cohort study of adult patients admitted to the Intensive Care Unit (ICU) of the Aga Khan Hospital, Dar-es-Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the type of support provided with worst physiological data within the first hour after admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model to predict outcome was assessed by discrimination and calibration. Discrimination between survivors and non – survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test.

Results. A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n=208, 62.8%), of African origin (n=178, 53.8%) and admitted from the emergency department (n=306, 92.4%). In-hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the ROC curve for SAPS 3 and MPM0-III was 0.89 (95%CI: 0.844-0.935) and 0.90 (95%CI: 0.864-0.944) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with chi-square values of 4.61 and 5.08 respectively and P–Value >0.05.

Conclusion. Both SAPS 3 and MPM0-III performed in predicting outcome among patients admitted to the intensive care unit of a private tertiary hospital. The overall in hospital mortality among critically ill patients was lower compared to reported mortality from studies done in other intensive care units in tertiary referral hospitals within Tanzania.

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