Comparison of European system for cardiac operative risk evaluation (EuroSCORE) II with the postoperative outcomes in patients undergoing cardiac surgery (original) (raw)
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Accuracy, calibration and clinical performance of the new EuroSCORE II risk stratification system
European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been used for many years since its introduction in 1999. Recently, a new EuroSCORE (EuroSCORE II) has been developed to update the previous version. The EuroSCORE II includes some different predictors and/or introduces a new classification of the already existing predictors. This study presents a validation series for the EuroSCORE II compared with the previous additive and the logistic EuroSCORE and with the Age, Creatinine and Ejection Fraction (ACEF) score.
European Journal of Cardio-Thoracic Surgery, 2005
Background: To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative length of stay and specific major postoperative complications after coronary artery bypass grafting (CABG). Methods: Data on 3760 consecutive patients with CABG were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, prolonged length of stay (> 12 days) and major postoperative complications (stroke, myocardial infarction, sternal infection, bleeding, sepsis and/or endocarditis, gastrointestinal complications, renal and respiratory failure). A C statistic (receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer -Lemeshow goodness-of-fit statistic. Results: In-hospital mortality was 2.7%, and 13.7% of patients had one or more major complications. EuroSCORE showed very good discriminatory ability in predicting renal failure (C statistic: 0.80) and good discriminatory ability in predicting in-hospital mortality (C statistic: 0.75), sepsis and/or endocarditis (C statistic: 0.72) and prolonged length of stay (C statistic: 0.71). There were no differences in terms of the discriminatory ability between standard and logistic EuroSCORE. Standard EuroSCORE showed good calibration (Hosmer -Lemeshow: P > 0.05) in predicting these outcomes except for postoperative length of stay, while logistic EuroSCORE showed good calibration only in predicting renal failure. Conclusions: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also prolonged length of stay and specific postoperative complications such as renal failure and sepsis and/or endocarditis after CABG. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation. D
Interactive CardioVascular and Thoracic Surgery, 2013
The aim of this study was to compare additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II and the Society of Thoracic Surgeons (STS) models in calculating mortality risk in a Turkish cardiac surgical population. METHODS: The current patient population consisted of 428 patients who underwent isolated coronary artery bypass grafting (CABG) between 2004 and 2012, extracted from the TurkoSCORE database. Observed and predicted mortalities were compared for the additive/logistic EuroSCORE, EuroSCORE II and STS risk calculator. The area under the receiver operating characteristics curve (AUC) values were calculated for these models to compare predictive power. RESULTS: The mean patient age was 74.5 ± 3.9 years at the time of surgery, and 35.0% were female. For the entire cohort, actual hospital mortality was 7.9% (n = 34; 95% confidence interval [CI] 5.4-10.5). However, the additive EuroSCORE-predicted mortality was 6.4% (P = 0.23 vs observed; 95% CI 6.2-6.6), logistic EuroSCORE-predicted mortality was 7.9% (P = 0.98 vs observed; 95% CI 7.3-8.6), EuroSCORE II-predicted mortality was 1.7% (P = 0.00 vs observed; 95% CI 1.6-1.8) and STS predicted mortality was 5.8% (P = 0.10 vs observed; 95% CI 5.4-6.2). The mean predictive performance of the analysed models for the entire cohort was fair, with 0.7 (95% CI 0.60-0.79). AUC values for additive EuroSCORE, logistic EuroSCORE, EuroSCORE II and STS risk calculator were 0.70 (95% CI 0.60-0.79), 0.70 (95% CI 0.59-0.80), 0.72 (95% CI 0.62-0.81) and 0.62 (95% CI 0.51-0.73), respectively. CONCLUSIONS: EuroSCORE II significantly underestimated mortality risk for Turkish cardiac patients, whereas additive and logistic EuroSCORE and STS risk calculators were well calibrated.
Heart, 2005
Objectives: To assess the value of the European system for cardiac operative risk evaluation (EuroSCORE), a validated model for prediction of in-hospital mortality after cardiac surgery, in predicting long term event-free survival. Design and setting: Single institution observational cohort study. Patients: Adult patients (n = 1230) who underwent cardiac surgery between January 2000 and August 2002. Results: Mean age was 65 (11) years and 32% were women. Type of surgery was isolated coronary artery bypass grafting in 62%, valve surgery in 23%, surgery on the thoracic aorta in 4%, and combined or other procedures in 11%. Mean EuroSCORE was 4.53 (3.16) (range 0-21); 366 were in the low (0-2), 442 in the medium (3-5), 288 in the high (6-8), and 134 in the very high risk group (> 9). Information on deaths or events leading to hospital admission after the index discharge was obtained from the Regional Health Database. Out of hospital deaths were identified through the National Death Index. In-hospital 30 day mortality was 2.8% (n = 34). During 2024 person-years of follow up, 44 of 1196 patients discharged alive (3.7%) died. By Cox multivariate analysis, EuroSCORE was the single best independent predictor of long term all cause mortality (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.03 to 2.34, p , 0.0001). In the time to first event analysis, 227 either died without previous events (n = 20, 9%) or were admitted to hospital for an event (n = 207, 91%). EuroSCORE (HR 1.60, 95% CI 1.36 to 1.89, p , 0.0001), the presence of > 2 co-morbidities versus one (HR 1.49, 95% CI 1.09 to 2.02, p , 0.0001), and . 96 hours' stay in the intensive care unit after surgery (HR 2.04, 95% CI 1.42 to 2.95, p = 0.0001) were independently associated with the combined end point of death or hospital admission after the index discharge. Conclusions: EuroSCORE and a prolonged intensive care stay after surgery are associated with long term event-free survival and can be used to tailor long term postoperative follow up and plan resource allocation for the cardiac surgical patient.
Validation of EuroSCORE II on a single-centre 3800 patient cohort
Interactive CardioVascular and Thoracic Surgery, 2012
OBJECTIVES: To compare and validate the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with EuroSCORE at our institution. METHODS: The logistic EuroSCORE and EuroSCORE II were calculated on the entire patient cohort undergoing major cardiac surgery at our centre between January 2005 and December 2010. The goodness of fit was compared by means of the Hosmer-Lemeshow (HL) chi-squared test and the area under the curve (AUC) of the receiver operating characteristic curves of both scales applied to the same sample of patients. These analyses were repeated and stratified by the type of surgery. RESULTS: Mortality of 5.66% was observed, with estimated mortalities according to logistic EuroSCORE and EuroSCORE II of 9 and 4.46%, respectively. The AUC for EuroSCORE (0.82, 95% confidence interval [CI] 0.79-0.85) was lower than that for EuroSCORE II (0.85, 95% CI 0.83-0.87) without the differences being statistically significant (P = 0.056). Both scales showed a good discriminative capacity for all the pathologies subgroups. The two scales showed poor calibration in the sample: EuroSCORE (χ 2 = 39.3, P HL < 0.001) and EuroSCORE II (χ 2 = 86.69, P HL < 0.001). The calibration of EuroSCORE was poor in the groups of patients undergoing coronary (P HL = 0.01), valve (P HL = 0.01) and combined coronary valve surgery (P HL = 0.012); and that of EuroSCORE II in the group of coronary (P HL = 0.001) and valve surgery (P HL < 0.001) patients. CONCLUSIONS: EuroSCORE II demonstrated good discriminative capacity and poor calibration in the patients undergoing major cardiac surgery at our centre.
Vojnosanitetski Pregled, 2019
Background/Aim. The EuroSCORE II has recently been developed with an idea to provide better accuracy in prediction of perioperative mortality in the patients who underwent open heart surgery. The aim of this study was to validate clinical performances of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk stratification model in the Serbian adult cardiac surgical population undergoing open heart surgery. Methods. The Euro-SCORE II values on 10,048 consecutive patients undergoing major adult cardiac surgery from 1st January 2012 to 31st March 2017, were prospectively calculated and entered the institutional database. The discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by the Hosmer-Lemeshow (H-L) statistics and the observed to expected (O/E) mortality ratio. The patients with the EuroSCORE II values of 0.5-2.50%, > 2.50-6.50%), and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Results. The observed in-hospital mortality was 3.86% (388 of 10,048) and the mean predicted mortality by the Euro-SCORE II was 3.61%. The discriminatory power was very Key words: mortality; predictive value of tests; risk assessment; thoracic surgical procedures. Apstrakt Uvod/Cilj. EuroSCORE II je razvijen nedavno sa idejom da se obezbedi bolja tačnost u predviđanju perioperativnog mortaliteta bolesnika podvrgnutih operacijama na otvorenom srcu. Cilj rada je bio da se provere kliničke performanse modela za stratifikaciju operativnog rizika u kardiohirur-giji-EuroSCORE II (Evropski sistem za procenu kadiohirurškog operativnog rizika) kod odraslih bolesnika u Srbiji kod kojih se izvode kardiohirurške procedure. Metode. Vrednosti EuroSCORE II za 10 048 uzastopno operisanih (od 1. januara 2012. do 31. marta 2017. godine) odraslih kardiohirurških bolesnika prospektivno su izračunate i unete u bazu podataka Instituta za kardiovaskularne bolesti Ključne reči: mortalitet; testovi, prognostička vrednost; rizik, procena; hirurgija, torakalna, procedure.
Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery?
European Journal of Cardio-Thoracic Surgery, 2009
Objective: Risk stratification allows preoperative assessment of cardiac surgical risk faced by individual patients and permits retrospective analysis of postoperative complications in the intensive care unit (ICU). The aim of this single-center study was to investigate the prediction of extended ICU stay after cardiac surgery using both the additive and logistic model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Methods: A retrospective observational study was conducted. We collected clinical data of 1562 consecutive patients undergoing cardiac surgery over a 2-year period at the Antwerp University Hospital, Belgium. EuroSCORE values of all patients were obtained. The outcome measure was the duration of ICU stay in days. The predictive performance of EuroSCORE was analyzed by the discriminatory power of a receiver operating characteristic (ROC) curve. Each EuroSCORE value was used as a theoretical cut-off point to predict duration of ICU stay. Three subsequent ICU stays were defined as prolonged: more than 2, 5 and 7 days. ROC curves were constructed for both the additive and logistic model. Results: Patients had a median ICU stay of 2 days and a mean ICU stay of 5.5 days. Median additive EuroSCORE was 5 (range, 0-22) and logistic EuroSCORE was 3.94% (range, 0.00-87.00). In the additive EuroSCORE model, a predictive value of 0.76 for an ICU stay of >7 days, 0.72 for >5 days and 0.67 for >2 days was found. The logistic EuroSCORE model yielded an area under the ROC curve of 0.77, 0.75 and 0.68 for each ICU length of stay, respectively. Conclusions: In our patient database, prolonged length of stay in the ICU correlated positively with EuroSCORE. The logistic model was more discriminatory than the additive in tracing extended ICU stay. The overall predictive performance of EuroSCORE is acceptable and most likely based on the presence of variables that are risk factors for both mortality and extended ICU stay. Hence, EuroSCORE is a useful predicting tool and provides both surgeons and intensivists with a good estimate of patient risk in terms of ICU stay. #
Logistic or additive EuroSCORE for high-risk patients?
Objectives: To assess whether the use of the full logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) is superior to the standard additive EuroSCORE in predicting mortality in high-risk cardiac surgical patients. Methods: Both the simple additive EuroSCORE and the full logistic EuroSCORE were applied to 14,799 cardiac surgical patients from across Europe, of whom there were 4293 high-risk patients (additive EuroSCORE of 6 or more). The systems were compared for absolute prediction and discrimination (area under the receiver operating characteristic (ROC) curve). Results: Actual mortality was 4.72%. The logistic model was closer to this than the additive model (4.84% (4.72-4.94) versus 4.21 (4.21 -4.26)). Most of this difference was due to high-risk patients where actual mortality was 11.18% and predicted was 7.83% (additive) and 11.23% (logistic). Discrimination was similar in both systems as measured by the area under the ROC curve (additive 0.783, logistic 0.785). Conclusions: The additive EuroSCORE model remains a simple "gold standard" for risk assessment in European cardiac surgery, usable at the bedside without complex calculations or information technology. The logistic model is a better risk predictor especially in high-risk patients and may be of interest to institutions engaged in the study and development of risk stratification. q (S.A.M. Nashef).
Prospective validation of EuroSCORE II in patients undergoing cardiac surgery in Argentinean centres
Interactive cardiovascular and thoracic surgery, 2014
The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is an updated version of the original EuroSCORE that must be extensively validated. The objective was to prospectively evaluate the efficacy of EuroSCORE II in predicting the immediate results of cardiac surgery in Argentinean centres. A prospective consecutive series of 503 adults who underwent cardiac surgery between January 2012 and April 2013 was studied. EuroSCORE II discrimination and accuracy were assessed in the overall cohort and in two surgically defined subgroups: isolated coronary artery bypass graft (CABG) surgery and non-CABG surgery. Additionally, a risk-adjusted cumulative sum control chart analysis was performed. In-hospital overall mortality rate was 4.17%, while the mortality rate predicted by the EuroSCORE II was 3.18% (P = 0.402). Receiver operating characteristic curve analysis demonstrated a good overall (area 0.856) and non-CABG subgroup (area 0.857) discrimination (P = 0.0001), while...