APPLICATION OF THE APACHE-III PROGNOSTIC SYSTEM IN BRAZILIAN INTENSIVE-CARE UNITS - A PROSPECTIVE MULTICENTER STUDY

Objective: To compare patients and their outcomes at ten Brazilian int ensive care units (ICUs) with those reported from the United States. D esign. Prospective multicenter inception cohort study. Setting: Ten Br azilian adult medical-surgical ICUs. Patients. 1734 consecutive adult ICU admissions. Measurements and results. We used demographic, clinica l and physiologic information and the APACHE III prognostic system to predict risk of hospital death for 1734 ICU admissions, We then divide d the observed by the predicted hospital death rate to calculate stand ardized mortality ratios (SMRs) for patient groups and each ICU, Hospi tal mortality for Brazilian patients (34%) was double that found in th e United States (17%, p < 0.01). Discrimination of survivors from non- survivors using APACHE III was good (area under a receiver operating c haracteristic curve = 0.82), but the predicted risk of death was signi ficantly (p < 0.0001) lower than observed outcome (SMR = 1.67). Three of the ten Brazilian ICUs, however, had SMRs of 1.01 to 1.1 and no sig nificant difference between observed and predicted outcomes; the remai ning seven ICUs had significantly higher SMRs, ranging from 1.50 to 2. 30. Conclusion: The APACHE III prognostic system was a good discrimina tor of hospital mortality for ICU admissions at 10 Brazilian ICUs, The re was substantial and significant variation, however, in SMRs among t he Brazilian ICUs, which suggests that further evaluations of internat ional differences in intensive care using a common risk assessment sys tem should be performed and factors associated with variations in risk -adjusted mortality scrutinized.