Performance of Simplified Acute Physiology Score (SAPS II Score) in Predicting Short- and Midterm Survival in Critically Ill Patients Prior to LVAD Implantation

Objective: Several scores have been developed for predicting outcome after LVAD implantation. However scores comprehensively evaluating the organ functions in patients with advanced or initial end-organ deterioration have been not yet explored. In the present report we sought to evaluate the performance of SAPS II score in predicting short and mid-term outcome in patients admitted to ICU for end-organ deterioration prior to LVAD-Implantation.

Methods: Between July 2010 and January 2017 a total of 59 (median age 55 years; IQR 19; 15 females) out of 180 CF-VAD recipients were preoperatively admitted to ICU because hemodynamically critical conditions. Mean preoperative INTERMACS score was 2.5, a total of 20 patients were bridged with an ECMO to LVAD-implantation. SAPS II score were automatically calculated from our ICU database.

Results: Kaplan Meier analysis showed a survival rate of 84.4, 70.9 and 64.3 at 1, 12 and 24 months respectively. 90-day survival rate was 81.4% (11 deaths); There was a significant difference in SAPS II score between alive patients and patients who died (median SAPS II score 36 vs 54; p = 0.014). ROC curve analysis showed an AUC of 0.74 (CI 0.61 to 0.84; p = 0.009) indicating a good predicting performance. Stratification according to interquartile ranges showed a significant survival difference (p = 0.03) on follow-up of high risk group (SAPS II >46 IQR 4) when compared with the low (SAPS II < 29, IQR 1) and the intermediate risk groups (SAPS II between 29 and 46 IQR 2–3).

Conclusion: SAPS II score shows good performance in predicting short- and mid-term survival. This can help physicians to risk stratification prior to LVAD implantation. High risk patients may deserve a closer score monitoring and potentially a different strategy to improve end-organ function and consequently survival.