Evaluation of the EuroSCORE in high risk patients undergoing cardiac surgery

Casalino, S.; Stelian, E.; Mangia, F.; Novelli, Eugenio; Renzi, Lorenzo; Alessi, C.; Diena, Marco

doi:10.1097/00003643-200706003-00065

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“…Because of this limitation, the STS risk scoring system cannot be used to study other types of cardiac surgery that are not yet included. On the other hand, the other most commonly used scoring system (the EuroScore II) that was designed to expect mortality in various surgical cases showed poor clinical relevance in the segment of patients where it is needed the most, i.e., the high risk and emergency cases [23][24][25]. Many studies have shown a significant discrepancy between observed and expected mortality in those patients when calculated by EuroScore II which sometimes overestimates [24] and in other times underestimates mortality [23] in high-risk patients [23,24] as well as in emergency surgery [25].…”

Section: Discussionmentioning

confidence: 99%

Index of deterioration of patients with mechanical prosthetic heart valve thrombosis

et al. 2020

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Background Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes. Results The median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05). ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities. Conclusion The simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT.

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