Estimates mortality in ICU patients, comparable to APACHE II.
Why Use
Can be used to measure quality of care in the ICU (but should not be used to predict survival of an individual).
Formula
SAPS II Score is calculated by addition of the selected points below. In-hospital mortality, % = e x / 1+ e x where x = −7.7631 + 0.0737 x (SAPS II Score) + 0.9971 x [ ln(SAPS II Score + 1) ] SAPS II Score: Variable Points Age, years <40 0 40-59 7 60-69 12 70-74 15 75-79 16 ≥80 18 Heart rate Worst value in 24 hours; if patient has had both cardiac arrest (11 points) and extreme tachycardia (7 points), assign 11 points <40 11 40-69 2 70-119 0 120-159 4 ≥160 7 Systolic BP, mm Hg Worst value in 24 hours <70 13 70-99 5 100-199 0 ≥200 2 Temperature ≥39ºC (102.2ºF) Highest temperature in 24 hours No 0 Yes 3 GCS Lowest value in 24 hours; if patient is sedated, use estimated GCS before sedation 14-15 0 11-13 5 9-10 7 6-8 13 <6 26 PaO₂/FiO₂, if on mechanical ventilation or CPAP Lowest value in 24 hours; if patient was extubated <24 hours ago, use lowest value while on mechanical ventilation <100 mm Hg/% (13.3 kPa/%) 11 100-199 mm Hg/% (13.3-26.5 kPa/%) 9 ≥200 mm Hg/% (26.6 kPa/%) 6 Not on mechanical ventilation or CPAP within the last 24 hours 0 BUN, mg/dL (serum urea, mmol/L) Highest value in 24 hours BUN <28 or urea <10 0 BUN 28-83 or urea 10-29.6 6 BUN ≥84 or urea ≥30 10 Urine output, mL/day If patient in ICU <24 hours, calculate for 24 hours (e.g. if 1 L in 8 hours, then mark 3 L in 24 hours) <500 11 500-999 4 ≥1,000 0 Sodium, mEq/L or mmol/L Worst value in 24 hours <125 5 125-144 0 ≥145 1 Potassium, mEq/L Worst value in 24 hours <3.0 3 3.0-4.9 0 ≥5.0 3 Bicarbonate, mEq/L Lowest value in 24 hours <15 6 15-19 3 ≥20 0 Bilirubin Highest value in 24 hours <4.0 mg/dL (<68.4 µmol/L) 0 4.0-5.9 mg/dL (68.4-102.5 µmol/L) 4 ≥6.0 mg/dL (≥102.6 µmol/L) 9 WBC, x 10³/mm³ Worst value in 24 hours <1.0 12 1.0-19.9 0 ≥20.0 3 Chronic disease None 0 Metastatic cancer 9 Hematologic malignancy 10 AIDS 17 Type of admission Scheduled surgical = surgery scheduled ≥24 hours in advance Medical = no surgery within one week of admission Unscheduled surgical = surgery scheduled ≤24 hours in advance Scheduled surgical 0 Medical 6 Unscheduled surgical 8
Pearls / Pitfalls
The worst physiological variables, corresponding to the highest number of points, should be collected within the first 24 hours of ICU admission. Superior to the original SAPS system, exhibiting a higher AUROC (0.86) than the original (0.80). Burn and cardiac patients were excluded from the original study, so while there is some evidence suggesting that SAPS II may perform well for these patient groups, this area requires study before SAPS II is used for these patients. Estimates mortality risk for a group of patients, but is not intended to describe an individual patient’s chance of survival.
Advice
Scores can be studied within a single ICU setting for quality improvement and other initiatives.
More Information
Interpretation: In-hospital mortality, % = e x / 1+ e x where x = −7.7631 + 0.0737 x (SAPS II Score) + 0.9971 x [ ln(SAPS II Score + 1) ]