Validation of SAPS 3 for predicting in-hospital mortality in patients with haematological malignancy requiring ICU management

Abstract

Prognostic systems predicting death risk may vary for patients with haematological malignancies needing ICU care. This study externally validated SAPS 3 using a retrospective cohort of adults with these conditions in the ICU. The score was calculated at admission using the general and South America-adjusted formulas. Mortality discrimination was assessed via AUC-ROC, and calibration by Hosmer-Lemeshow goodness-of-fit and graphical analysis with a calibration belt. The analysis included 273 admissions, with 119 deaths. Discriminative capacity was low (AUC-ROC 0.56, CI 95% 0.49–0.63). There was a poor correlation between expected and observed events across all risk deciles (Hosmer-Lemeshow 10.45, p = 0.0635). Similar results were found with the South America-adjusted formula. SAPS 3 does not effectively discriminate between survivors and non-survivors, underestimating risk in low-risk groups and overestimating it in high-risk groups. Mortality risk estimation in this scenario should rely on clinical judgment.