本文采用的英格恩产品: CCAA细胞凋亡检测试剂盒(PI)
Evaluation of the SMS-ICU score for multicontinental use: A federated external validation study using critical care registry data
Affiliations
- 1 Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
- 2 National Intensive Care Surveillance-MORU, Colombo, Sri Lanka.
- 3 Instituto D’Or de Pesquisa e Ensino Rio de Janeiro, Brazil.
- 4 Postgraduate Program, Instituto D’Or de Pesquisa e Ensino Rio de Janeiro, Brazil.
- 5 Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.
- 6 Department of Medicine, Chittagong Medical College, Chittagong, Bangladesh.
- 7 Nepal Intensive Care Research Foundation (NICRF), Nepal.
- 8 National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands.
- 9 Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, and Amsterdam Public Health, Methodology and Digital Health, Amsterdam, the Netherlands.
- 10 Intensive Care Unit, Hospital Maciel, Montevideo, Montevideo, Uruguay.
- 11 Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
- 12 The Alfred Intensive Care Academic Centre, Bayside Health, Melbourne, Australia.
- 13 Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- 14 Mario Negri Institute for Pharmacological Research IRCCS, Laboratory of Clinical Data Science, Department of Medical Epidemiology, Lombardia, Italy.
- 15 Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, and University of Eastern Finland, Kuopio, Finland.
- 16 Department of Critical Care Medicine, Apollo Hospitals, Chennai, India.
- 17 Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Kuala Lumpur, Malaysia.
- 18 Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa.
- 19 Centre for the Study of Antimicrobial Resistance, South African Medical Research Council and University of Cape Town, Cape Town, South Africa.
- 20 The Australian and New Zealand Intensive Care (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, Australia.
- 21 Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari “Aldo Moro”, Bari, Italy.
- 22 Mahidol Oxford Tropical Research Unit (MORU), Bangkok, Thailand.
- 23 Department of Anaesthesia and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
- 24 Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
- 25 Department of Anaesthesia and Peri-operative Medicine, Division of Critical Care, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
- 26 DataHealth Lab, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
- 27 Pulmonary Division, Faculty of Medicine, Heart Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
- PMID: 42633258
- PMCID: PMC13499179
- DOI: 10.1016/j.ccrj.2026.100206
Abstract
Objective: To evaluate the suitability of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) for use in critical care registries across multiple continents.
Design: A federated external validation study.
Setting: Intensive care units (ICUs) belonging to 12 critical care registries on five continents.
Participants: Individuals over the age of 18 years who were admitted to participating ICUs during the 2023 calendar year. Readmissions within the same hospital encounter and interhospital transfers were excluded.
Interventions: None.
Main outcome measures: The primary outcome was all-cause in-hospital mortality. A secondary analysis considered ICU mortality.
Results: 12 registries participated (three from Africa, four from Asia, one from Oceania, two from Europe and two from South America). In total, 494,705 admissions were included from 546 ICUs in 13 countries. Seven registries systematically reported hospital outcomes and were included in the primary analysis. Discrimination was acceptable (pooled area under the receiver operating characteristic curve [AUROC] 0.76 [95% CI 0.72-0.80]). Calibration and overall model fit varied between registries (Brier scores 0.09-0.14). In the secondary analysis of ICU outcomes in all 12 registries, discrimination remained acceptable but with higher variation between registries (pooled AUROC 0.73 [0.69-0.77]). Calibration and overall model fit also varied widely (Brier scores 0.07-0.46).
Conclusions: SMS-ICU may be used as an index of illness severity in international intensive care populations. This may facilitate international collaborative research and synthesis of findings in systematic reviews and meta-analyses.
Keywords: Global health; Intensive care; Mortality; Prognosis; Registries; Severity of illness; Severity of illness index.
