What’s new?
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The EuroSCORE I, developed in 1999, has been an important risk model in cardiac surgery; its successor, EuroSCORE II, was presented in 2012 but has not been validated in a Dutch cohort
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We performed a validation study to assess whether or not the EuroSCORE II was a valid risk model in a Dutch hospital
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The EuroSCORE II outperformed its predecessor in a Dutch single-centre validation study, with the exception of emergency surgery
Introduction
Materials and methods
Data collection
Patient sample and analyses
Results
Patient characteristics
Pre-operative variables
a
|
Missing
| |
Age (years) | – | 70 (63–76) |
Female gender | – | 662 (28.8) |
Weight (kg) | – | 80 (71–90) |
Previous cardiac surgery | – | 171 (7.4) |
Previous myocardial infarction | – | 311 (13.5) |
NYHA class | – | |
– I | 942 (41.0) | |
– II | 694 (30.2) | |
– III | 484 (21.1) | |
– IV | 176 (7.7) | |
LMCA >50% occluded | 4 | 299 (13.0) |
Left ventricular hypertrophy | 24 | 536 (23.3) |
Pulmonary artery pressure >40 mm Hg | – | 58 (2.5) |
Atrial fibrillation | 1 | 399 (17.4) |
Extra cardiac arteriopathy | – | 311 (13.5) |
Hypertension | 8 | 1,445 (62.9) |
Pre-operative Hb level (g/dl) | – | 13.7 (12.6–14.8) |
Creatinine level (µmol/l) | – | 84 (72–100) |
Creatinine clearance | – | 80 (60–101) |
Ejection fraction | – | |
– good | 1,758 (76.6) | |
– moderate | 377 (16.4) | |
– poor | 136 (5.9) | |
– very poor | 25(1.1) | |
Smoking | 19 | 366 (15.9) |
Insulin-dependent diabetes | – | 284 (12.4) |
Endocarditis | – | 28 (1.2) |
Chronic renal failureb | – | 50 (2.2) |
COPD | – | 267 (11.6) |
Poor mobility | – | 167 (7.3) |
Pre-operative use of inotropic agents | – | 25 (1.1) |
Respiratory insufficiency | – | 65 (2.8) |
Jehovah’s witnesses | 2 | 32 (1.4) |
Emergency surgery | – | 261 (11.4) |
Aortic valve pathology | – | 793 (34.5) |
Mitral valve pathology | – | 469 (20.4) |
Type of surgery | – | |
– CABG | 1,059 (46.1) | |
– CABG + other surgery | 319 (13.9) | |
– Valve | 615 (26.8) | |
– Miscellaneous surgery | 303 (13.2) | |
Off-pump procedure | – | 139 (6.1) |
Additive EuroSCORE I | – | 5 (3–8) |
Logistic EuroSCORE I | – | 10.7 (5.8–13.9) |
EuroSCORE II | – | 1.6 (1.0–3.5) |
Intra-operative variables
|
Missing
| |
Time in surgery (min) | 11 | 215 (180–255) |
CPB time (min) | – | 83 (61–117) |
Clamp time (min) | – | 54 (36–78) |
Intra-operative nadir Hb (g/dl) | 15 | 9.7 (8.4–10.8) |
Performance of the EuroSCORE II
Area under the curve | Observed mortality Number (%) | Expected mortality Median (IQR) | O/E ratio | |
---|---|---|---|---|
Additive EuroSCORE I | 0.840 (0.798–0.882) | 55 (2.4) | 5.0 (3.0–8.0) | 0.48 |
Logistic EuroSCORE I | 0.761 (0.695–0.828) | 55 (2.4) | 10.7 (5.8–13.9) | 0.22 |
EuroSCORE II | 0.871 (0.832–0.911) | 55 (2.4) | 1.6 (1.0–3.5) | 1.50 |
EuroSCORE II performance in different types of surgery
Area under the curve | Observed mortality Number (%) | Expected mortality Median (IQR) | O/E ratio | |
---|---|---|---|---|
Discrimination and calibration according to surgical procedure
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CABG (n = 1,059) | ||||
– Additive EuroSCORE I | 0.900 (0.838–0.962) | 13 (1.2) | 4.0 (3.0–6.0) | 0.30 |
– Logistic EuroSCORE I | 0.691 (0.536–0.846) | 13 (1.2) | 10.6 (4.8–13.7) | 0.11 |
– EuroSCORE II | 0.884 (0.809–0.958) | 13 (1.2) | 1.4 (0.93–2.6) | 0.86 |
CABG + other procedure (n = 319) | ||||
– Additive EuroSCORE I | 0.739 (0.648–0.831) | 14 (4.4) | 7.0 (5.0–9.0) | 0.63 |
– Logistic EuroSCORE I | 0.812 (0.695–0.929) | 14 (4.4) | 10.3 (5.5–13.8) | 0.43 |
– EuroSCORE II | 0.693 (0.566–0.820) | 14 (4.4) | 3.4 (2.0–6.5) | 1.29 |
Valve (n = 615) | ||||
– Additive EuroSCORE I | 0.833 (0.722–0.943) | 13 (2.1) | 7.0 (5.0–9.0) | 0.30 |
– Logistic EuroSCORE I | 0.755 (0.594–0.917) | 13 (2.1) | 11.2 (8.8–14.2) | 0.19 |
– EuroSCORE II | 0.866 (0.768–0.964) | 13 (2.1) | 1.5 (1.0–3.1) | 1.40 |
Miscellaneous procedures (n = 303) | ||||
– Additive EuroSCORE I | 0.819 (0.732–0.907) | 15 (5.0) | 5.0 (2.0–9.0) | 1.00 |
– Logistic EuroSCORE I | 0.784 (0.692–0.876) | 15 (5.0) | 10.3 (4.5–14.2) | 0.49 |
– EuroSCORE II | 0.912 (0.862–0.962) | 15 (5.0) | 1.5 (0.7–4.7) | 3.33 |
Discrimination and calibration according to urgency
| ||||
Elective surgery (n = 2,035) | ||||
– Additive EuroSCORE I | 0.827 (0.779–0.875) | 30 (1.5) | 5.0 (3.0–7.0) | 0.30 |
– Logistic EuroSCORE I | 0.720 (0.621–0.818) | 30 (1.5) | 10.5 (5.2–13.7) | 0.14 |
– EuroSCORE II | 0.839 (0.784–0.894) | 30 (1.5) | 1.5 (0.92–2.9) | 1.00 |
Emergency surgery (n = 261) | ||||
– Additive EuroSCORE I | 0.726 (0.616–0.836) | 25 (9.6) | 10.0 (7.0–13.0) | 0.96 |
– Logistic EuroSCORE I | 0.729 (0.631–0.826) | 25 (9.6) | 12.9 (9.2–17.5) | 0.74 |
– EuroSCORE II | 0.816 (0.736–0.896) | 25 (9.6) | 5.9 (2.2–13.2) | 1.63 |