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

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.