Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort (original) (raw)
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Validation of the EuroSCORE risk models in Turkish adult cardiac surgical population
Objective: The aim of this study was to validate additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) models on Turkish adult cardiac surgical population. Methods: TurkoSCORE project involves a reliable web-based database to build up Turkish risk stratification models. Current patient population consisted of 9443 adult patients who underwent cardiac surgery between 2005 and 2010. However, the additive and logistic EuroSCORE models were applied to only 8018 patients whose EuroSCORE determinants were complete. Observed and predicted mortalities were compared for low-, medium-, and high-risk groups. Results: The mean patient age was 59.5 years (AE12.1 years) at the time of surgery, and 28.6% were female. There were significant differences (all p < 0.001) in the prevalence of recent myocardial infarction (23.5% vs 9.7%), moderate left ventricular function (29.9% vs 25.6%), unstable angina (9.8% vs 8.0%), chronic pulmonary disease (13.4% vs 3.9%), active endocarditis (3.2% vs 1.1%), critical preoperative state (9.0% vs 4.1%), surgery on thoracic aorta (3.7% vs 2.4%), extracardiac arteriopathy (8.6% vs 11.3%), previous cardiac surgery (4.1% vs 7.3%), and other than isolated coronary artery bypass graft (CABG; 23.0% vs 36.4%) between Turkish and European cardiac surgical populations, respectively. For the entire cohort, actual hospital mortality was 1.96% (n = 157; 95% confidence interval (CI), 1.70—2.32). However, additive predicted mortality was 2.98% (p < 0.001 vs observed; 95%CI, 2.90— 3.00), and logistic predicted mortality was 3.17% (p < 0.001 vs observed; 95%CI, 3.03—3.21). The predictive performance of EuroSCORE models for the entire cohort was fair with 0.757 (95%CI, 0.717—0.797) AUC value (area under the receiver operating characteristic, AUC) for additive EuroSCORE, and 0.760 (95%CI, 0.721—0.800) AUC value for logistic EuroSCORE. Observed hospital mortality for isolated CABG was 1.23% (n = 75; 95%CI, 0.95—1.51) while additive and logistic predicted mortalities were 2.87% (95%CI, 2.82—2.93) and 2.89% (95%CI, 2.80—2.98), respectively. AUC values for the isolated CABG subset were 0.768 (95%CI, 0.707—0.830) and 0.766 (95%CI, 0.705—0.828) for additive and logistic EuroSCORE models. Conclusion: The original EuroSCORE risk models overestimated mortality at all risk subgroups in Turkish population. Remodeling strategies for EuroSCORE or creation of a new model is warranted for future studies in Turkey.
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2011
This study aimed to evaluate the accuracy of Euroscore (European System for Cardiac Operative Risk Evaluation) in predicting perioperative mortality after cardiac surgery in Iranian patient population. Data on 1362 patients undergoing coronary bypass graft surgery (CABG) from 2007 to 2009 were collected. Calibration was assessed by Hosmer-Lemeshow goodness-of-fit. Area under the curve (AUC) was used to assess score validity. Odds ratios were measured to evaluate the predictive value of each risk factor on mortality rate. The overall perioperative in hospital mortality was 3.6% whereas the Euroscore predicted a mortality of 3.96%. Euroscore model fitted well in the validation databases. The mean AUC was 66%. Mean length of intensive care unit (ICU) stay was 2.5 ± 2.5 days. Among risk factors, only left ventricular dysfunction, age and neurologic dysfunction were found to be related to mortality rate. Euroscore did not have acceptable discriminatory ability in perioperative in hospita...
Annals of Cardiovascular and Thoracic Surgery
Objective: The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population in order to validate its use in our country. Methods: This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1 st January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the ROC curve and analyzing its calibration using the Hosmer-Lemeshow statistics. Results: The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve >0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining ρ values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). Conclusion: The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.
EuroSCORE overestimates the cardiac operative risk
Cardiovascular Surgery, 2003
information on risk factors and mortality was collected for 1123 consecutive adult patients undergoing heart surgery with cardiopulmonary bypass. EuroSCORE was used for risk stratification. Mean age ± standard deviation was 58.6 ± 10.9 and 29.1% of the patients were female. The area under the receiver operating characteristic (ROC) curve was calculated as an index for the predictive value of the scoring system.
The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk?
Heart, 2006
Objectives: To study the ability of the logistic EuroSCORE to predict operative risk in contemporary cardiac surgery. Design: Retrospective analysis of prospectively collected data. Setting: All National Health Service centres undertaking adult cardiac surgery in northwest England. Patients: All patients undergoing cardiac surgery between April 2002 and March 2004. Main outcome measures: The predictive ability of the logistic EuroSCORE was assessed by analysing how well it discriminates between patients with differing observed risk by using the area under the receiver operating characteristic (ROC) curve and studying how well it is calibrated against observed in-hospital mortality. The performance of the EuroSCORE was examined in the following surgical subgroups: all cardiac surgery, isolated coronary artery surgery, isolated valve surgery, combined valve and coronary surgery, mitral valve surgery, aortic valve surgery and other surgery. Results: 9995 patients underwent surgery. The discrimination of the logistic EuroSCORE was good with a ROC curve area of 0.79 for all cardiac surgery (range 0.71-0.79 in the subgroups). For all operations, the predicted mortality was 5.7% and observed mortality was 3.3%. The logistic EuroSCORE overpredicted observed mortality for all subgroups but by differing degrees (p = 0.02) Conclusions: The logistic EuroSCORE is a reasonable overall predictor for contemporary cardiac surgery but overestimates observed mortality. Its accuracy at predicting risk in different surgical subgroups varies. The logistic EuroSCORE should be recalibrated before it is used to gain reassurance about outcomes. Caution should be exercised when using it to compare hospitals or surgeons with a different operative case mix. 1817 www.heartjnl.com
2018 Fatima Jinnah Medical University, Lahore, Pakistan. , 2018
Background: Models have been developed to predict a variety of outcomes, for all cardiac surgery and also for specific cardiac surgery procedures. The most broadly utilized model for anticipating mortality in cardiovascular surgery was EuroSCORE I which has been upgraded in recent times to EuroSCORE II. The objective of the present study was to evaluate the efficacy of the EuroSCORE II in anticipating the mortality in patients experiencing cardiac surgery. Subjects and methods: Cross-sectional observational study from a sample of 101 cardiac surgery patients was conducted to evaluate the outcomes (length of stay at ICU and hospital and mortality) of postoperative cardiac surgery in relation to EuroSCORE II at Punjab Institute of Cardiology Lahore from 22 nd April, 2016 to 15 th December, 2016. Results: Mean values of WBCs, serum creatinine and bilirubin total were significantly increased from preoperative to postoperative-I and a minor decrease on the postoperative II readings whereas mean values of hemoglobin and platelets constantly (p-value<0.01) declined after surgery. Mean values of blood urea and ALT increased sequentially during preoperative, postoperative-I and postoperative-II laboratory investigations. In addition, positive relationship of EuroSCORE II with ICU stay (r = 0.205, p-value<0.05) and ventilation time (r = 0.232, p-value<0.05) were observed. In addition to these results, there were 98 (97.0%) patients discharged after cardiac surgery and 3 (3.0%) patients expired. Conclusion: The risk prediction from EuroSCORE II is best suited for low and medium risk group patients but it was not appropriate for high risk patients.
Brazilian Journal of Cardiovascular Surgery
Introduction: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.
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.
2021
BACKGROUND The European system for cardiac operative risk evolution (EuroSCORE) II is one of the established risk models used to predict mortality after cardiac surgery. However, its application as a mortality predictor for Indonesian adult cardiac surgery is still unknown. This study aimed to examine the validation of EuroSCORE II in predicting mortality following cardiac surgery in Indonesian adults. METHODS This retrospective cohort study collected data from the medical records and the database of the Department of Thoracic Cardiac and Vascular Surgery at Soetomo General Hospital, Surabaya. Data on the EuroSCORE II variables were collected for patients aged >18 years who underwent coronary artery bypass, heart valve, heart tumors, aortic surgeries, or a combination of these surgeries between January 2016 and December 2018. In-hospital mortality prediction was calculated using the online calculator at www.euroscore.org. The calibration of the EuroSCORE II model was conducted us...