This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Jean-Roger Le Gall, MD; Stanley Lemeshow, PhD; Fabienne Saulnier, MD

JAMA. 1993;270(24):2957-2963.

Abstract
Objective.
—To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method to convert the score to a probability of hospital mortality.

Design and Setting.
—The SAPS II and the probability of hospital mortality were developed and validated using data from consecutive admissions to 137 adult medical and/or surgical intensive care units in 12 countries.

Patients.
—The 13 152 patients were randomly divided into developmental (65%) and validation (35%) samples. Patients younger than 18 years, burn patients, coronary care patients, and cardiac surgery patients were excluded.

Outcome Measure.
—Vital status at hospital discharge.

Results.
—The SAPS II includes only 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Goodness-of-fit tests indicated that the model performed well in the developmental sample and validated well in an independent sample of patients (P=.883 and P=.104 in the developmental and validation samples, respectively). The area under the receiver operating characteristic curve was 0.88 in the developmental sample and 0.86 in the validation sample.

Conclusion.
—The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis. This is a starting point for future evaluation of the efficiency of intensive care units.

(JAMA. 1993;270:2957-2963)

Author Affiliations
From the Faculty of Medicine Lariboisière-Saint-Louis, Paris, France (Dr Le Gall); the School of Public Health, University of Massachusetts, Amherst (Dr Lemeshow); and The Evaluation Center of Lille (France) (Dr Saulnier).

Footnotes
A complete list of study participants appears at the end of this article.

Reprint requests to Service de Réanimation Médicale, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, Paris, France 75010 (Dr Le Gall).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Procoagulant alveolar microparticles in the lungs of patients with acute respiratory distress syndrome
Bastarache et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2009;297:L1035-L1041.
ABSTRACT | FULL TEXT  

Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome: A Randomized Controlled Trial
Taccone et al.
JAMA 2009;302:1977-1984.
ABSTRACT | FULL TEXT  

An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling
Silke et al.
QJM 2009;0:hcp149v1-hcp149.
ABSTRACT | FULL TEXT  

Prolonged mechanical ventilation after cardiac surgery: Outcome and predictors
Trouillet et al.
J. Thorac. Cardiovasc. Surg. 2009;138:948-953.
ABSTRACT | FULL TEXT  

Application of the Sequential Organ Failure Assessment (SOFA) Score to Patients With Cancer Admitted to the Intensive Care Unit
Namendys-Silva et al.
AM J HOSP PALLIAT CARE 2009;26:341-346.
ABSTRACT  

Measurement of extravascular lung water using the single indicator method in patients: research and potential clinical value
Brown et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2009;297:L547-L558.
ABSTRACT | FULL TEXT  

Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units
Farfel et al.
Age Ageing 2009;38:515-520.
ABSTRACT | FULL TEXT  

Urine Neutrophil Gelatinase-Associated Lipocalin Moderately Predicts Acute Kidney Injury in Critically Ill Adults
Siew et al.
J. Am. Soc. Nephrol. 2009;20:1823-1832.
ABSTRACT | FULL TEXT  

Mortality Probability Model III and Simplified Acute Physiology Score II: Assessing Their Value in Predicting Length of Stay and Comparison to APACHE IV
Vasilevskis et al.
Chest 2009;136:89-101.
ABSTRACT | FULL TEXT  

Alveolar Extracellular 20S Proteasome in Patients with Acute Respiratory Distress Syndrome
Sixt et al.
Am. J. Respir. Crit. Care Med. 2009;179:1098-1106.
ABSTRACT | FULL TEXT  

Prognosis and prognostic research: application and impact of prognostic models in clinical practice
Moons et al.
BMJ 2009;338:b606-b606.
FULL TEXT  

Outcomes of critically ill patients with acute kidney injury and end-stage renal disease requiring renal replacement therapy: a case-control study
Rocha et al.
Nephrol Dial Transplant 2009;24:1925-1930.
ABSTRACT | FULL TEXT  

Clara Cell Protein (CC16), a Marker of Lung Epithelial Injury, Is Decreased in Plasma and Pulmonary Edema Fluid From Patients With Acute Lung Injury
Kropski et al.
Chest 2009;135:1440-1447.
ABSTRACT | FULL TEXT  

Nonthyroidal Illness Syndrome and Prolonged Mechanical Ventilation in Patients Admitted to the ICU
Bello et al.
Chest 2009;135:1448-1454.
ABSTRACT | FULL TEXT  

Macroscopic Postmortem Findings in 235 Surgical Intensive Care Patients with Sepsis
Torgersen et al.
Anesth. Analg. 2009;108:1841-1847.
ABSTRACT | FULL TEXT  

Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events
Kelen et al.
dmphp 2009;3:S10-S16.
ABSTRACT | FULL TEXT  

Vitamin D Deficiency in Critically Ill Patients
Lee et al.
NEJM 2009;360:1912-1914.
FULL TEXT  

Role of SCCmec Type in Outcome of Staphylococcus aureus Bacteremia in a Single Medical Center
Ganga et al.
J. Clin. Microbiol. 2009;47:590-595.
ABSTRACT | FULL TEXT  

Prognosis and prognostic research: what, why, and how?
Moons et al.
BMJ 2009;338:b375-b375.
FULL TEXT  

Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients
Schuetz et al.
Eur J Endocrinol 2009;160:157-163.
ABSTRACT | FULL TEXT  

Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery
Lerolle et al.
Chest 2009;135:401-407.
ABSTRACT | FULL TEXT  

Marginal structural models for partial exposure regimes
Vansteelandt et al.
Biostatistics 2009;10:46-59.
ABSTRACT | FULL TEXT  

Nutrition Assessment in Critically Ill Patients
Sungurtekin et al.
Nutr Clin Pract 2008;23:635-641.
ABSTRACT | FULL TEXT  

Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit
Sakr et al.
Br J Anaesth 2008;101:798-803.
ABSTRACT | FULL TEXT  

Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery
Ahlers et al.
Br J Anaesth 2008;101:781-787.
ABSTRACT | FULL TEXT  

Breathing cardiovascular variability and baroreflex in mechanically ventilated patients
Van de Louw et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2008;295:R1934-R1940.
ABSTRACT | FULL TEXT  

Swallowing Disorders as a Predictor of Unsuccessful Extubation: A Clinical Evaluation
Colonel et al.
Am J Crit Care 2008;17:504-510.
ABSTRACT | FULL TEXT  

Early Administration of High-Dose Antithrombin in Severe Sepsis: Single Center Results from the KyberSept-Trial
Eid et al.
Anesth. Analg. 2008;107:1633-1638.
ABSTRACT | FULL TEXT  

Low tidal volume ventilation is associated with reduced mortality in HIV-infected patients with acute lung injury
Davis et al.
Thorax 2008;63:988-993.
ABSTRACT | FULL TEXT  

Predictors of mortality in acute lung injury during the era of lung protective ventilation
Seeley et al.
Thorax 2008;63:994-998.
ABSTRACT | FULL TEXT  

Case volume and mortality in haematological patients with acute respiratory failure
Lecuyer et al.
Eur Respir J 2008;32:748-754.
ABSTRACT | FULL TEXT  

Short- and Long-term Outcomes of Critically Ill Patients With Cancer and Prolonged ICU Length of Stay
Soares et al.
Chest 2008;134:520-526.
ABSTRACT | FULL TEXT  

Prognostic Value of Chromogranin A at Admission in Critically Ill Patients: A Cohort Study in a Medical Intensive Care Unit
Zhang et al.
Clin. Chem. 2008;54:1497-1503.
ABSTRACT | FULL TEXT  

Impact of antibiotics on the gut microbiota of critically ill patients
Iapichino et al.
J Med Microbiol 2008;57:1007-1014.
ABSTRACT | FULL TEXT  

Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients
Annane et al.
Am. J. Respir. Crit. Care Med. 2008;178:20-25.
ABSTRACT | FULL TEXT  

Variation in ICU Risk-Adjusted Mortality: Impact of Methods of Assessment and Potential Confounders
Kuzniewicz et al.
Chest 2008;133:1319-1327.
ABSTRACT | FULL TEXT  

Cell-Free Plasma DNA as a Predictor of Outcome in Severe Sepsis and Septic Shock
Saukkonen et al.
Clin. Chem. 2008;54:1000-1007.
ABSTRACT | FULL TEXT  

Vascular Endothelial Growth Factor in Severe Sepsis and Septic Shock
Karlsson et al.
Anesth. Analg. 2008;106:1820-1826.
ABSTRACT | FULL TEXT  

Decreased Expression of the Fractalkine Receptor CX3CR1 on Circulating Monocytes as New Feature of Sepsis-Induced Immunosuppression
Pachot et al.
J. Immunol. 2008;180:6421-6429.
ABSTRACT | FULL TEXT  

Predicting death and readmission after intensive care discharge
Campbell et al.
Br J Anaesth 2008;100:656-662.
ABSTRACT | FULL TEXT  

Definitive Care for the Critically Ill During a Disaster: A Framework for Allocation of Scarce Resources in Mass Critical Care: From a Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL
Devereaux et al.
Chest 2008;133:51S-66S.
ABSTRACT | FULL TEXT  

Intra-alveolar tissue factor pathway inhibitor is not sufficient to block tissue factor procoagulant activity
Bastarache et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2008;294:L874-L881.
ABSTRACT | FULL TEXT  

A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients
Bagshaw et al.
Nephrol Dial Transplant 2008;23:1203-1210.
ABSTRACT | FULL TEXT  

Accuracy of Bedside Glucometry in Critically Ill Patients: Influence of Clinical Characteristics and Perfusion Index
Desachy et al.
Mayo Clin Proc. 2008;83:400-405.
ABSTRACT | FULL TEXT  

Withholding and Withdrawing Dialysis in the Intensive Care Unit: Benefits Derived from Consulting the Renal Physicians Association/American Society of Nephrology Clinical Practice Guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis
Patel and Holley
CJASN 2008;3:587-593.
ABSTRACT | FULL TEXT  

Positive End-Expiratory Pressure Setting in Adults With Acute Lung Injury and Acute Respiratory Distress Syndrome: A Randomized Controlled Trial
Mercat et al.
JAMA 2008;299:646-655.
ABSTRACT | FULL TEXT  

Regulation of hepatocyte growth factor secretion by fibroblasts in patients with acute lung injury
Quesnel et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2008;294:L334-L343.
ABSTRACT | FULL TEXT  

Hydrocortisone Therapy for Patients with Septic Shock
Sprung et al.
NEJM 2008;358:111-124.
ABSTRACT | FULL TEXT  

Inflammation-associated ADAMTS13 deficiency promotes formation of ultra-large von Willebrand factor
Bockmeyer et al.
haematol 2008;93:137-140.
ABSTRACT | FULL TEXT  

Prostaglandin E2 Mediates IL-1 -Related Fibroblast Mitogenic Effects in Acute Lung Injury through Differential Utilization of Prostanoid Receptors
White et al.
J. Immunol. 2008;180:637-646.
ABSTRACT | FULL TEXT  

Sex-and age-based differences in the delivery and outcomes of critical care
Fowler et al.
CMAJ 2007;177:1513-1519.
ABSTRACT | FULL TEXT  

Influence of Gender on the Outcome of Severe Sepsis: A Reappraisal
Adrie et al.
Chest 2007;132:1786-1793.
ABSTRACT | FULL TEXT  

Short- and Long-term Outcomes of Heatstroke Following the 2003 Heat Wave in Lyon, France
Argaud et al.
Arch Intern Med 2007;167:2177-2183.
ABSTRACT | FULL TEXT  

Clinical Utility of B-Type Natriuretic Peptide in Early Severe Sepsis and Septic Shock
Rivers et al.
J Intensive Care Med 2007;22:363-373.
ABSTRACT  

Chlorhexidine-Based Antiseptic Solution vs Alcohol-Based Povidone-Iodine for Central Venous Catheter Care
Mimoz et al.
Arch Intern Med 2007;167:2066-2072.
ABSTRACT | FULL TEXT  

Antithrombin Levels, Morbidity, and Mortality in a Surgical Intensive Care Unit
Sakr et al.
Anesth. Analg. 2007;105:715-723.
ABSTRACT | FULL TEXT  

An Update on the Diagnosis of Adrenal Insufficiency and the Use of Corticotherapy in Critical Illness
Thomas and Fraser
The Annals of Pharmacotherapy 2007;41:1456-1465.
ABSTRACT | FULL TEXT  

Analysis of 30-Day Mortality for Clostridium difficile-Associated Disease in the ICU Setting
Kenneally et al.
Chest 2007;132:418-424.
ABSTRACT | FULL TEXT  

Comparison of the SpO2/FIO2 Ratio and the PaO2/FIO2 Ratio in Patients With Acute Lung Injury or ARDS
Rice et al.
Chest 2007;132:410-417.
ABSTRACT | FULL TEXT  

The alveolar epithelium can initiate the extrinsic coagulation cascade through expression of tissue factor
Bastarache et al.
Thorax 2007;62:608-616.
ABSTRACT | FULL TEXT  

Time course and relationship between plasma selenium concentrations, systemic inflammatory response, sepsis, and multiorgan failure
Sakr et al.
Br J Anaesth 2007;98:775-784.
ABSTRACT | FULL TEXT  

Platelet Count Decline: An Early Prognostic Marker in Critically Ill Patients With Prolonged ICU Stays
Moreau et al.
Chest 2007;131:1735-1741.
ABSTRACT | FULL TEXT  

Septic Acute Kidney Injury in Critically Ill Patients: Clinical Characteristics and Outcomes
Bagshaw et al.
CJASN 2007;2:431-439.
ABSTRACT | FULL TEXT  

Argatroban Anticoagulation in Critically Ill Patients
Beiderlinden et al.
The Annals of Pharmacotherapy 2007;41:749-754.
ABSTRACT | FULL TEXT  

Outcome of Patients With Small-Vessel Vasculitis Admitted to a Medical ICU
Khan et al.
Chest 2007;131:972-976.
ABSTRACT | FULL TEXT  

Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score: reply
Adrie and Monchi
Eur Heart J 2007;28:773-774.
FULL TEXT  

Prognosis of Lung Cancer Patients With Life-Threatening Complications
Soares et al.
Chest 2007;131:840-846.
ABSTRACT | FULL TEXT  

ACE I/D but not AGT (-6)A/G polymorphism is a risk factor for mortality in ARDS
Adamzik et al.
Eur Respir J 2007;29:482-488.
ABSTRACT | FULL TEXT  

Effects of hydroxyethyl starch administration on renal function in critically ill patients
Sakr et al.
Br J Anaesth 2007;98:216-224.
ABSTRACT | FULL TEXT  

Pharmacokinetics of Intravenous Linezolid in Cerebrospinal Fluid and Plasma in Neurointensive Care Patients with Staphylococcal Ventriculitis Associated with External Ventricular Drains
Beer et al.
Antimicrob. Agents Chemother. 2007;51:379-382.
ABSTRACT | FULL TEXT  

Mediators or Markers of Injury, Inflammation, and Infection (Harbingers of Doom or Predictors of Disaster) and Biologic Puzzles or Ambiguities
Baue
Arch Surg 2007;142:89-93.
FULL TEXT  

Diagnosis of Adrenal Insufficiency in Severe Sepsis and Septic Shock
Annane et al.
Am. J. Respir. Crit. Care Med. 2006;174:1319-1326.
ABSTRACT | FULL TEXT  

Relation of the Sequential Organ Failure Assessment Score to Morbidity and Mortality After Cardiac Surgery
Patila et al.
Ann. Thorac. Surg. 2006;82:2072-2078.
ABSTRACT | FULL TEXT  

Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score
Adrie et al.
Eur Heart J 2006;27:2840-2845.
ABSTRACT | FULL TEXT  

Arterial Versus Plethysmographic Dynamic Indices to Test Responsiveness for Testing Fluid Administration in Hypotensive Patients: A Clinical Trial
Natalini et al.
Anesth. Analg. 2006;103:1478-1484.
ABSTRACT | FULL TEXT  

Copeptin and Arginine Vasopressin Concentrations in Critically Ill Patients
Jochberger et al.
J. Clin. Endocrinol. Metab. 2006;91:4381-4386.
ABSTRACT | FULL TEXT  

The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit
Kellett and Deane
QJM 2006;99:771-781.
ABSTRACT | FULL TEXT  

Posttraumatic cerebral infarction in patients with moderate or severe head trauma.
Marino et al.
Neurology 2006;67:1165-1171.
ABSTRACT | FULL TEXT  

Frequency and predictors of colonization of the respiratory tract by VIM-2-producing Pseudomonas aeruginosa in patients of a newly established intensive care unit.
Horianopoulou et al.
J Med Microbiol 2006;55:1435-1439.
ABSTRACT | FULL TEXT  

A rural emergency medical retrieval service: the first year.
Corfield et al.
Emerg. Med. J. 2006;23:679-683.
ABSTRACT | FULL TEXT  

Extracellular heat shock protein 72 is a marker of the stress protein response in acute lung injury
Ganter et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2006;291:L354-L361.
ABSTRACT | FULL TEXT  

Prognosis of Critically Ill Patients With Cancer and Acute Renal Dysfunction
Soares et al.
JCO 2006;24:4003-4010.
ABSTRACT | FULL TEXT  

A single nucleotide polymorphism of macrophage migration inhibitory factor is related to inflammatory response in coronary bypass surgery using cardiopulmonary bypass.
Lehmann et al.
Eur. J. Cardiothorac. Surg. 2006;30:59-63.
ABSTRACT | FULL TEXT  

Dissociation of Serum Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate in Septic Shock
Arlt et al.
J. Clin. Endocrinol. Metab. 2006;91:2548-2554.
ABSTRACT | FULL TEXT  

Erythropoiesis Abnormalities Contribute to Early-Onset Anemia in Patients with Septic Shock
Claessens et al.
Am. J. Respir. Crit. Care Med. 2006;174:51-57.
ABSTRACT | FULL TEXT  

Receptor for Advanced Glycation End-Products Is a Marker of Type I Cell Injury in Acute Lung Injury
Uchida et al.
Am. J. Respir. Crit. Care Med. 2006;173:1008-1015.
ABSTRACT | FULL TEXT  

Lung recruitment in patients with the acute respiratory distress syndrome.
Gattinoni et al.
NEJM 2006;354:1775-1786.
ABSTRACT | FULL TEXT  

Predicting Survival in Patients Requiring Renal Replacement Therapy After Cardiac Surgery
Leacche et al.
Ann. Thorac. Surg. 2006;81:1385-1392.
ABSTRACT | FULL TEXT  

Outcome of Critically Ill Allogeneic Hematopoietic Stem-Cell Transplantation Recipients: A Reappraisal of Indications for Organ Failure Supports
Pene et al.
JCO 2006;24:643-649.
ABSTRACT | FULL TEXT