How does EuroSCORE II perform in UK cardiac surgery; an analysis of 23 740 patients from the Society for Cardiothoracic Surgery in Great Britain and Ireland National Database

Grant, Stuart W; Hickey, Graeme L.; Dimarakis, Ioannis; Trivedi, Uday; Bryan, Alan J.; Treasure, Tom; Cooper, Graham; Pagano, Domenico; Buchan, Iain; Bridgewater, Ben

doi:10.1136/heartjnl-2012-302483

Cited by 95 publications

(65 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There is evidence that both ES and ES2 are miscalibrated on contemporary NACSA data, due to differences in characteristics between NACSA and the original datasets on which the two scores were derived 43,45 . Moreover, the predicted (risk-adjusted) mortality has increased over time in the dataset from 6.09% and 2.93% (2007/08) to 6.51% and 3.26% (2011/12) for ES and ES2 respectively.…”

Section: Comparative Evaluation Setupmentioning

confidence: 99%

A review of statistical updating methods for clinical prediction models

Jaki

Hickey

et al. 2016

Stat Methods Med Res

Self Cite

113

127

View full text Add to dashboard Cite

A clinical prediction model (CPM) is a tool for predicting healthcare outcomes, usually within a specific population and context. A common approach is to develop a new CPM for each population and context, however, this wastes potentially useful historical information. A better approach is to update or incorporate the existing CPMs already developed for use in similar contexts or populations. In addition, CPMs commonly become miscalibrated over time, and need replacing or updating. In this paper we review a range of approaches for re-using and updating CPMs; these fall in three main categories: simple coefficient updating; combining multiple previous CPMs in a meta-model; and dynamic updating of models. We evaluated the performance (discrimination and calibration) of the different strategies using data on mortality following cardiac surgery in the UK: We found that no single strategy performed sufficiently well to be used to the exclusion of the others. In conclusion, useful tools exist for updating existing CPMs to a new population or context, and these should be implemented rather than developing a new CPM from scratch, using a breadth of complementary statistical methods.

show abstract

Section: Comparative Evaluation Setupmentioning

confidence: 99%

A review of statistical updating methods for clinical prediction models

Jaki

Hickey

et al. 2016

Stat Methods Med Res

Self Cite

113

127

View full text Add to dashboard Cite

show abstract

“…In addition, the improvement in predictive performance of the EuroSCORE II is still not fully established. 1,[29][30][31] Eighth, the sample size in the subgroups was not sufficient to test for interaction in the association between cardiac markers and outcome within specific surgical procedures. However, we did not find any evidence for interaction in the subgroup with isolated CABG versus other procedures.…”

Section: Strength and Limitationsmentioning

confidence: 99%

Troponin T and B-Type Natriuretic Peptide After On-Pump Cardiac Surgery

et al. 2014

View full text Add to dashboard Cite

Surgical risk stratification models, 1 including the European System for Cardiac Operative Risk Evaluation (EuroSCORE), 2,3 exclusively consider preoperative and intraoperative risk factors. Although useful for healthcare planning and for preoperative risk/benefit assessments, this view may prove fragmentary postoperatively, because it disregards perioperative myocardial ischemic events 4,5 or postoperative complications 6-8 despite their association with mortality. Therefore, there is a need for tools that allow for early postoperative risk reassessment to guide management decisions (eg, transfer to step-down units and postdischarge follow-up schedules). Editorial see p 932 Clinical Perspective on p 957Troponin T (TNT) has an established prognostic value for short-term 9-11 and midterm outcomes 12-14 after cardiac surgery. However, previous studies on the predictive value of troponin 9-11 have focused on preoperative risk factors and have not accounted for postoperative complications (eg, infections or acute kidney failure). In-hospital complications, however, may exert a relevant prognostic change by being associated with both elevated cardiac biomarkers postoperatively and midterm outcome.Several studies have described the association between preoperative natriuretic peptides and outcomes after cardiac surgery. 15,16 Evidence supporting the prognostic value of postoperative concentrations, in contrast, is scarce [17][18][19][20][21][22] and has been generated mostly in small studies 17,21,22 that are underpowered Background-The independent predictive value of troponin T (TNT) after on-pump cardiac surgery was established in several studies. However, adjustment was limited to preoperative risk factors without considering perioperative complications. Data on the prognostic value of postoperative B-type natriuretic peptide (BNP) are scarce. Our aim was to assess the independent value of TNT and BNP to predict 12-month outcome after cardiac surgery with adjustment for preoperative risk estimates and postoperative complications and to report risk stratification gains when considering the European System for Cardiac Operative Risk Evaluation (EuroSCORE) combined with postoperative biomarkers. Methods and Results-This prospective cohort study included consecutive patients undergoing on-pump cardiac surgery between 2007 and 2010. We evaluated postoperative TNT and BNP, the EuroSCORE, and postoperative complications as predictors of adverse events using Cox regression. The primary end point was death or major adverse cardiac events within 1 year after surgery. We calculated the net reclassification index of TNT and BNP in addition to the EuroSCORE. We enrolled 1559 patients, of whom 176 (11.3%) experienced an event. The adjusted hazard ratio of TNT >0.8 μg/L was 2.13 (95% confidence interval, 1.47-3.15) and of BNP >790 ng/L was 2.44 (95% confidence interval, 1.65-3.62). The net reclassification index of the addition of TNT and BNP to the EuroSCORE was 0.276 (95% confidence interval, 0.195-0.348). Conclusions-Postoper...

show abstract

“…19 Carnero-Alcazar ve ark.nın çalışmasında da koroner arter baypas operasyonu olanlarda göz-lenen mortalite (%3,09) beklenen mortaliteden (%3,28) düşük bulunmakla birlikte bu farklılığın istatistiksel olarak anlamlı olmadığı bildirilmiştir. 20 Chalmers ve ark.nın çalışmasında da koroner baypas operasyonlarında gözlenen mortalite %1,9 beklenen mortalite ise %1,7 (%1,1-3,3) bulunmuş olup bu değerler istatistiksel olarak benzerdir.…”

Section: Discussionunclassified

Expected and Observed Mortality in Patients Undergoing Coronary Artery Bypass Surgery

Gökçimen¹,

Uğuz²,

Çiçek³

et al. 2015

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

Anahtar Kelimeler: Mortalite; koroner arter baypas ABSTRACT Objective: The aim of this study is to investigate the expected mortality rates calculated with EuroSCORE II and observed mortality rates in patients undergoing coronary artery bypas surgery (CABG). Material and Methods: Patients who underwent CABG surgery in 2010 and 2011 in our clinic were included in this study. In this descriptive retrospective study, hospital database and patient files were scanned to obtain patients' data. We conducted post-discharge follow-up by phone calls. Results: Four hundred fifty-five patients who matched the criteria were included in this study. Mean age of the patients was 61.4±11.1 years and 94 (20.7%) of the patients were female. Sixteen (3.5%) patients were octogenarians. One hundred eighty-seven (41.1%) patients defined CCS Class IV angina and 22 (4.8%) were in NYHA class IV functional capacity. Expected mortality rate was 3.5% (95% CI=3.0-4.0) and observed mortality rate was 3.1% (95% CI=1.5-4.7), and did not reveal a significant difference. According to EuroSCORE II, the area under ROC curve was 0.840 (95% CI= 0.747-0.933, p=0.000), and represented an excellent test. Calibration was tested with HomerLemeshow goodness of fit test (x²=15.872, df: 8, p= 0.044) and evaluated as not good. Conclusion: The observed mortality in this group of patients is relevant to expected mortality rate calculated with EuroSCORE II. The discrimination power of EuroSCORE II mortality risk model is excellent, but the calibration is not good. We recommend EuroSCORE II as a criterion for CABG surgery mortality risk modeling.

show abstract

How does EuroSCORE II perform in UK cardiac surgery; an analysis of 23 740 patients from the Society for Cardiothoracic Surgery in Great Britain and Ireland National Database

Cited by 95 publications

References 22 publications

A review of statistical updating methods for clinical prediction models

A review of statistical updating methods for clinical prediction models

Troponin T and B-Type Natriuretic Peptide After On-Pump Cardiac Surgery

Expected and Observed Mortality in Patients Undergoing Coronary Artery Bypass Surgery

Contact Info

Product

Resources

About