Validation of EuroSCORE II to predict mortality in post-cardiac surgery patients in East Java tertiary hospital (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.
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.
European Heart Journal Supplements, 2014
This paper was designed to review the risk for and the actual mortality rate of patients subjected to cardiac surgery at the King Abdulaziz Cardiac Center (KACC). The European System for Cardiac Operative Risk Evaluation (EuroSCORE I and EuroSCORE II) was used to assess the expected and observed operative risk of all (1176) patients undergoing cardiac surgery at the KACC from 2010 to 2012. The overall predicted mortality was 4.48% (SD 5.29) while the observed mortality was 1.27% (.30 days 0.42% and ,30 days 0.85%). For all coronary artery bypass grafting (CABG), the EuroSCORE I over estimated mortality (3.8% predicted vs. 0.97% observed). The same was found to be true for isolated CABG (3.8% predicted vs. 0.38% observed) and for CABG plus valve cases (predicted 8.34% vs. 3.4% observed) or isolated valvular surgery (5% predicted vs. 2.9% observed). EuroSCORE II also showed the same trend as EuroSCORE I in a smaller group of patients of 411 (3.08% predicted vs. 0.731% observed mortality). EuroSCORE I and EuroSCORE II overestimated the predicted mortality in our cardiac surgery patients.
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients. METHODS: Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed. RESULTS: Out 6293 procedures, 6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital mortality rate of 4.85% and EuroSCORE II of 4.40 ± 7.04%. The area under the receiver operator characteristic curve (0.830) showed good discriminative ability of EuroSCORE II in distinguishing patients who died and those who survived. Calibration of EuroSCORE II was preserved with lower predicted than observed risk in the highest EuroSCORE II deciles. At logistic regression analysis, the complete revision of the model had most of reestimated regression coefficients not statistically different from those in the original EuroSCORE II model. When missing values were replaced with the mean EuroSCORE II value according to urgency and weight of intervention, the risk score confirmed discrimination and calibration obtained over the entire sample. A recursive tree-building algorithm of EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1% of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2 and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk (mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good agreement between observed events and predicted frequencies by EuroSCORE II, whereas those at greater risk showed an underestimation of expected mortality. CONCLUSIONS: This study demonstrates that EuroSCORE II is a good predictor of hospital mortality after cardiac surgery in an external validation cohort of contemporary patients from a multicentre prospective regional registry. The EuroSCORE II predicts hospital mortality with a slight underestimation in high-risk patients that should be further and better evaluated. The EuroSCORE II variables as a risk tree provides clinicians and surgeons a practical bedside tool for mortality risk stratification of patients at low, intermediate and high risk for hospital mortality after cardiac surgery.
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.
Nepalese Heart Journal
Background: Logistic Euroscore and Euroscore II are widely used in predicting perioperative mortality after cardiac surgery; however the data regarding the superiority of one over the other in predicting outcome regarding 30 days mortality in isolated coronary artery surgeries are not consistent. This study assessed the predictive accuracy of logistic Euroscore versus Euroscore II in determining 30 days mortality after isolated CABG surgery in a single cardiac center of Nepal. Methods: One hundred and forty-two patients scheduled for isolated coronary artery bypass surgery during the one-year period was taken for this prospective observational study. The predictive post-operative mortality was calculated using both of the scoring system. The actual mortality observed during the 30 day of postoperative period was recorded and the findings were compared with the predictive post-operative mortality according to the scoring systems by using area under the receiver operating characterist...
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...
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: Age, creatinine, ejection fraction (ACEF) score is a simplified algorithm for prediction of mortality after elective cardiac surgery. Although mainly conceived for elective cardiac surgery, no information is available on its performance in non-elective surgery and on comparison with the new EuroSCORE II. This study was undertaken to compare the performance of ACEF score and EuroSCORE II within classes of urgency. METHODS: Complete data on 13 871 consecutive patients who underwent major cardiac surgery in a 6-year period were retrieved from three prospective institutional databases. Discriminatory power was assessed using the c-index and h with Delong, bootstrap and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. RESULTS: The in-hospital mortality rate was 2.5%. The discriminatory power of ACEF score within elective and non-elective surgery was similar (area under the curve (AUC) 0.71, 95% confidence interval (CI) 0.67-0.74 and AUC 0.68, 95% CI 0.62-0.73, respectively) but significantly lower than that of EuroSCORE II (AUC 0.80, 95% CI 0.77-0.83 for elective surgery; AUC 0.82, 95% CI 0.78-0.85 for non-elective surgery). The calibration patterns were different in the two subgroups, but the summary statistics underscored a miscalibration in both of them (U-statistic and Spiegelhalter Z-test P-values <0.05). Even the calibration of EuroSCORE II was insufficient, although it was demonstrated to be well calibrated in the first tertile of predicted risk. CONCLUSIONS: This study demonstrated that the performance of ACEF score in predicting in-hospital mortality in elective and nonelective cardiac surgery is comparable. Nonetheless, it is not as satisfactory as the new EuroSCORE II, as its discrimination is significantly lower and it is also miscalibrated.
The EuroSCORE: a neglected measure of medium-term survival following cardiac surgery†
Interactive cardiovascular and thoracic surgery, 2015
EuroSCORE is used to predict operative mortality following cardiac surgery. There are limited data to assess the ability of EuroSCORE to predict medium- to long-term survival. We aimed to test the ability of EuroSCORE to predict mid-term survival following cardiac surgery. We analysed prospectively collected data from all patients undergoing cardiac surgery in an urban tertiary cardiac centre over a 6-year period. All-cause mortality following cardiac surgery was determined via Office of National Statistics data. Patients were grouped into all comers, coronary artery bypass graft (CABG), isolated aortic valve replacement (AVR), isolated mitral valve repair and replacement (MVR) and combined AVR/MVR and CABG. Each group was separated into EuroSCORE quartiles. Kaplan-Meier curves were used to calculate 6-year actuarial survival. Log-rank test was used to calculate the P-value. C-statistic discriminated the ability of the EuroSCORE to predict medium-term survival. A total of 9022 conse...
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.