ArticleAnnals of intensive care2016
External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome.
Article in Annals of intensive care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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15 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Predictive Value of the PaOInternal medicine (Tokyo, Japan) · 2025Pooled it
- Development and validation of a clinical risk model to predict the hospital mortality in ventilated patients with acute respiratory distress syndrome: a population-based study.BMC pulmonary medicine · 2022Trial
- Validation of age, PaORespiratory research · 2020Trial
- Mortality prediction for patients with acute respiratory distress syndrome based on machine learning: a population-based study.Annals of translational medicine · 2021Article
- The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients.Intensive care medicine experimental · 2020Article
- The predictive validity for mortality of the driving pressure and the mechanical power of ventilation.Intensive care medicine experimental · 2020Article
- The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview.Frontiers in medicine · 2020Review
- Associations between changes in oxygenation, dead space and driving pressure induced by the first prone position session and mortality in patients with acute respiratory distress syndrome.Journal of thoracic disease · 2019Article
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- Nomogram for the prediction of postoperative hypoxemia in patients with acute aortic dissection.BMC anesthesiology · 2018Article
- Smartphone Applications to Perform Body Balance Assessment: a Standardized Review.Journal of medical systems · 2018Review
- Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT.Annals of intensive care · 2018Article
- External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome.Intensive care medicine · 2017Article
- A new prediction score for critically ill patients-do we need an Apgar score for acute respiratory distress syndrome?Journal of thoracic disease · 2017Article
- Prognostic performance of the Age, PaOTherapeutic advances in infectious diseaseArticle
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as 'APPS') was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (ARDS). After thorough temporal external validation of the APPS, we tested the spatial external validity in a cohort of ARDS patients recruited during 3 years in two hospitals in the Netherlands.
methodsConsecutive patients with moderate or severe ARDS according to the Berlin definition were included in this observational multicenter cohort study from the mixed medical-surgical ICUs of two university hospitals. The APPS was calculated per patient with the maximal airway pressure instead of the plateau pressure as all patients were ventilated in pressure-controlled mode. The predictive accuracy for hospital mortality was evaluated by calculating the area under the receiver operating characteristics curve (AUC-ROC). Additionally, the score was recalibrated and reassessed.
resultsIn total, 439 patients with moderate or severe ARDS were analyzed. All-cause hospital mortality was 43 %. The APPS predicted all-cause hospital mortality with moderate accuracy, with an AUC-ROC of 0.62 [95 % confidence interval (CI) 0.56-0.67]. Calibration was moderate using the original cutoff values (Hosmer-Lemeshow goodness of fit P < 0.001), and recalibration was performed for the cutoff value for age and plateau pressure. This resulted in good calibration (P = 1.0), but predictive accuracy did not improve (AUC-ROC 0.63, 95 % CI 0.58-0.68).
conclusionsThe predictive accuracy for all-cause hospital mortality of the APPS was moderate, also after recalibration of the score, and thus the APPS does not seem to be fitted for that purpose. The APPS might serve as simple tool for stratification of mortality in patients with moderate or severe ARDS. Without recalibrations, the performance of the APPS was moderate and we should therefore hesitate to blindly apply the score to other cohorts of ARDS patients.
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