Evaluation of acute physiology and chronic health evaluation ii (apache-ii) vs. simplified acute physiology score ii (saps-ii) in an Iranian population: A multi-center prospective cross-sectional evaluation study.

Objectives: To evaluate APACHE-II and SAPS-II models in an Iranian population in order to support administrators in realistic planning and quality control process. Design: A prospective cross-sectional evaluation study. Setting: APACHE-II and SAPS-II were calculated for all consecutive admissions to four intensive care referral centers located in the top two most populated cities in Iran, from 2014 to 2017. The mortality rate in Iran and world standard rate were compared based on APACHE-II categories. Finally, the performance of models was assessed. Main outcome measures: Area under the Receiver Operating Characteristics Curve (AUC), the Brier score and Hosmer-Lemeshow (H-L) goodness-of-fit test were employed. Results: For 1946 patients, the overall observed mortality (23.7%) was more than international rates due to APACHE-II categories. The Brier score for APACHE-II and SAPS-II were 0.18 and 0.193, respectively. Although, none of prediction models were fitted to dataset (H-L ρ-value<0.01), both were associated with acceptable AUCs (APACHE-II=0.746 and SAPS-II=0.752). Conclusion: In this study, despite poor performance measures of APACHE-II and SAPS-II as the most used models in Iran, finding recalibrated version of these prediction models in the country is necessary before applying it as a clinical prioritization or quality control tool.