EuroSCORE II does not show better accuracy nor predictive power in comparison to original EuroSCORE: a single-centre study

Abstract

A b s t r a c tBackground: EuroSCORE is used to predict postoperative mortality in patients undergoing cardiac surgery. Its updated version was published in 2011. Aim:To assess whether EuroSCORE II (ESII) predicts more accurately postoperative mortality after cardiac surgery in comparison with additive (addES) and logistic EuroSCORE (logES). Methods:A total of 461 patients (aged 21-88 years, 63.4% of men) who underwent cardiac surgery (December 2010 -June 2011) were included into the prospective research. For each patient ESII, addES and logES were calculated. Accuracy, calibration, and clinical performance of these models were assessed with receiver operating characteristics analyses using the area under the curve and the Hosmer-Lemeshow test. Out of this population, a group of 300 coronary artery bypass grafting (CABG) patients (aged 42-85 years, 73% of men) was selected and statistically analysed using the same methods. Results:The mortality rate was 5.21%. Predicted mortality rates were as follows: addES 4.68%, logES 4.57%, and ESII 1.89%; the accuracy was: 0.589, 0.728, and 0.726, respectively. Only logES presented good predictive power (Hosmer-Lemeshow test: c 2 = 12.79, p = 0.12). In the CABG patients, the postoperative mortality rate was 5.33%. Predicted mortality rates were as follows: addES 4.69%, logES 4.59%, and ESII 1.88%; the accuracy was: 0.512, 0.691, and 0.687, respectively. In the Hosmer-Lemeshow test also logES presented good predictive power (c 2 = 10.72, p = 0.218). Conclusions:EuroSCORE II did not estimate mortality risk better in comparison to its previous versions, in the entire studied population or in the CABG patients. On the basis of the analysed data, it seems that the closest to the actual risk of death for the Polish population is the EuroSCORE logistic model. [1] is used to predict operative mortality in patients undergoing cardiac surgery. The scoring system was prepared using the most reliable and objective risk factors out of 97 risk factors collected from nearly 20,000 patients from 128 hospitals in eight European countries. All of the selected risk factors were divided into three groups: patient-related, cardiac-related, and operative-related factors. If

Multicenter prospective validation of the European System for Cardiac Operative Risk Evaluation II in Argentina

“…Other studies pointed out that this model might underestimate the risk of mortality in high-risk patients and in those undergoing combined surgery 10 . EuroSCORE II also seems to underestimate endocarditis surgery-associated mortality 11 and, in some European populations in particular; it does not estimate mortality better than the previous versions 12 . However, many of these criticisms were made shortly after the model was presented, and were softened in recent years as external prospective validations appeared.…”

Validación prospectiva multicéntrica del EuroSCORE II en Argentina

“…Otros estudios señalaron que este modelo podría subestimar el riesgo de mortalidad en pacientes de alto riesgo y en aquellos sometidos a cirugía combinada 10 . También el EuroSCORE II parece subestimar la mortalidad de la cirugía de la endocarditis 11 y, en algunas poblaciones europeas en particular, no estima mejor la mortalidad que las versiones anteriores 12 . Sin embargo, muchas de estas críticas fueron realizadas poco tiempo después de presentado el modelo, y suavizadas en los últimos años a medida que aparecieron las validaciones prospectivas externas.…”

“Wolfe procedure”—What is it? Did he describe resuspension or replacement?

“…It worth noting that he described a surgical procedure wherein, the aortic valve was resuspensed and supracoronray aorta was replaced. 3 In the recently published article, 4 [5][6][7] It is a well-known fact that the coronary artery of elderly patients has to be evaluated before any open-heart surgery; more so when having symptoms of angina. Though the authors mention that the elderly lady had coronary heart disease with class III angina pectoris, there is no description of the native coronary arteries in the manuscript.…”

“…It should be further emphasized, that the authors have not any mentioned any comorbidities of the patients including the left ventricular function while presenting the case. Earlier studies have reported the overestimation of surgical risk in septuagenarians and octogenarians by EuroSCORE II 5‐7 . It is a well‐known fact that the coronary artery of elderly patients has to be evaluated before any open‐heart surgery; more so when having symptoms of angina.…”