SAPS 3 admission score

Q: What is a normal SAPS 3 score?

There is no 'normal' value. In the derivation cohort the median was 48 (IQR 38–60) and the mean 49.9 ± 16.6; elective post-operative patients often score in the 20s.

Q: What is the difference between SAPS II and SAPS 3?

SAPS II uses the worst values of the first 24 hours; SAPS 3 uses data from ±1 hour around admission, so it describes the patient before ICU treatment has had an effect. SAPS 3 also adds regional equations.

Q: Why does SAPS 3 add 16 points?

Admission itself is given 16 points so that the negative weights (e.g. for transplantation or rhythm disturbances) cannot produce a total below zero.

Q: Is SAPS 3 mandatory in Austria?

Yes for adult intensive-care units that document for the LKF: SAPS 3 at admission (first hour) and TISS-A daily are part of the Austrian Intensivdokumentation.

ICU severity of illness from data within 1 hour of ICU admission

SAPS 3 — Vienna-coordinated (Metnitz, Moreno)
Austrian mandatory ICU documentation (SAPS3/TISS-A)
Multinational SAPS 3 cohort (303 ICUs, 35 countries)

Sources last checked: 2026-10-13

What is the SAPS 3 admission score?

SAPS 3 (Simplified Acute Physiology Score 3) rates severity of illness from 20 variables recorded within one hour of ICU admission: chronic health and pre-ICU care (Box I), the circumstances of admission (Box II) and acute physiology (Box III). It was developed by the SAPS 3 Outcomes Research Group led by Philipp Metnitz (Vienna) and Rui Moreno (Lisbon) from 16,784 patients in 303 ICUs across five continents (Intensive Care Med 2005). In Austria it is part of the mandatory intensive-care documentation and the basis of ASDI benchmarking.

When to use it

On ICU admission, to document case-mix and severity for quality reporting and benchmarking.
Austrian ICUs: the admission data set (Satzart I11 – SAPS3-Daten) in the Intensivdokumentation.
To calculate standardised mortality ratios (observed/expected) for an ICU or a patient group.
Risk adjustment in clinical studies of critically ill adults.

When not to use it

Children and adolescents (developed in patients aged ≥ 16 years).
As a sole basis for triage or limiting treatment of an individual patient.
For daily reassessment — SAPS 3 is an admission score; use SOFA or similar for organ dysfunction over time.

How it is calculated

Criterion	Points
Age
< 40 years	0
40–59 years	5
60–69 years	9
70–74 years	13
75–79 years	15
≥ 80 years	18
Cancer therapy (chemotherapy, immunosuppression, radiotherapy, steroids)	+3
Chronic heart failure NYHA IV	+6
Haematological cancer	+6
Cirrhosis	+8
AIDS	+8
Cancer (metastatic)	+11
Hospital stay before ICU admission
< 14 days	0
14–27 days	6
≥ 28 days	7
Intra-hospital location before ICU admission
Operating or recovery room	0
Emergency department	5
Other ICU	7
Ward or other	8
Vasoactive drugs before ICU admission	+3
ICU admission
Planned	0
Unplanned	3
Reason: cardiovascular — rhythm disturbances	-5
Reason: neurologic — seizures	-4
Reason: hypovolaemic shock (haemorrhagic or non-haemorrhagic)	+3
Reason: digestive — acute abdomen or other digestive	+3
Reason: coma, stupor, confusion, agitation, delirium	+4
Reason: septic shock	+5
Reason: anaphylactic, mixed or undefined shock	+5
Reason: liver failure	+6
Reason: focal neurologic deficit	+7
Reason: severe pancreatitis	+9
Reason: intracranial mass effect	+10
Surgical status at ICU admission
Scheduled surgery	0
No surgery	5
Emergency surgery	6
Anatomical site of surgery
No surgery / all other sites	0
Transplantation (liver, kidney, pancreas, other)	-11
Trauma (isolated thorax/abdomen/limb, or multiple)	-8
Cardiac: CABG without valve repair	-6
Neurosurgery for cerebrovascular accident	5
Acute infection at admission: nosocomial	+4
Acute infection at admission: respiratory	+5
Glasgow Coma Scale (lowest; estimated before sedation)
3–4	15
5	10
6	7
7–12	2
≥ 13	0
Total bilirubin (highest)
< 34.2 µmol/L (< 2 mg/dL)	0
34.2–102.5 µmol/L (2–5.9 mg/dL)	4
≥ 102.6 µmol/L (≥ 6 mg/dL)	5
Body temperature (highest)
< 35 °C	7
≥ 35 °C	0
Creatinine (highest)
< 106.1 µmol/L (< 1.2 mg/dL)	0
106.1–176.7 µmol/L (1.2–1.9 mg/dL)	2
176.8–309.3 µmol/L (2–3.4 mg/dL)	7
≥ 309.4 µmol/L (≥ 3.5 mg/dL)	8
Heart rate (highest)
< 120 /min	0
120–159 /min	5
≥ 160 /min	7
Leukocytes (highest)
< 15 G/L	0
≥ 15 G/L	2
pH (lowest)
≤ 7.25	3
> 7.25	0
Platelets (lowest)
< 20 G/L	13
20–49 G/L	8
50–99 G/L	5
≥ 100 G/L	0
Systolic blood pressure (lowest)
< 40 mmHg	11
40–69 mmHg	8
70–119 mmHg	3
≥ 120 mmHg	0
Oxygenation
Mechanical ventilation and PaO₂/FiO₂ < 100 mmHg (< 13.3 kPa)	11
Mechanical ventilation and PaO₂/FiO₂ ≥ 100 mmHg (≥ 13.3 kPa)	7
No mechanical ventilation and PaO₂ < 60 mmHg (< 8.0 kPa)	5
No mechanical ventilation and PaO₂ ≥ 60 mmHg (≥ 8.0 kPa)	0

SAPS 3 = 16 (admission offset) + Box I (age, comorbidities, length of stay, location, vasoactive drugs) + Box II (planned/unplanned, reasons, surgical status, site, infection) + Box III (GCS, bilirubin, temperature, creatinine, heart rate, leukocytes, pH, platelets, systolic BP, oxygenation) Predicted hospital mortality: logit = −32.6659 + ln(SAPS 3 + 20.5958) × 7.3068; p = e^logit / (1 + e^logit)

Clinical pearls and limitations

Use the worst value within 1 hour before or after ICU admission. Comorbidities, reasons for admission and infection sites are not mutually exclusive — score every one that applies. Values not measured are scored as normal (the Austrian documentation also treats an empty field as 'not pathological'). The paper's age row prints '>60<70'; it is applied here as 60–69 years. The score is for case-mix and benchmarking; it does not decide individual treatment limits.
Every patient starts with 16 points, so the minimum realistic score is around 16; the theoretical range is 0–217.
Box I (data available before ICU admission) carries about half of the prognostic information.
Some reasons for admission and surgical sites subtract points (rhythm disturbance −5, seizures −4, transplantation −11, trauma −8, CABG −6) because these patients do better than their physiology suggests.
Use the lowest GCS estimated before sedation; for sedated patients document the pre-sedation value.
Convert the score with the SAPS 3 mortality calculator; the Central/Western Europe equation fits Austrian ICUs better than the global one.

Frequently asked questions

What is a normal SAPS 3 score?

There is no 'normal' value. In the derivation cohort the median was 48 (IQR 38–60) and the mean 49.9 ± 16.6; elective post-operative patients often score in the 20s.

What is the difference between SAPS II and SAPS 3?

SAPS II uses the worst values of the first 24 hours; SAPS 3 uses data from ±1 hour around admission, so it describes the patient before ICU treatment has had an effect. SAPS 3 also adds regional equations.

Why does SAPS 3 add 16 points?

Admission itself is given 16 points so that the negative weights (e.g. for transplantation or rhythm disturbances) cannot produce a total below zero.

Is SAPS 3 mandatory in Austria?

Yes for adult intensive-care units that document for the LKF: SAPS 3 at admission (first hour) and TISS-A daily are part of the Austrian Intensivdokumentation.

Evidence and guidelines

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