Mortality Prediction in Cardiac Surgery Patients

Martínez-Alario, J.; Tuesta, Ignacio Díaz de; Plasencia, Eliseo; Santana, M. Cabrera; Mora, María L.

doi:10.1161/01.cir.99.18.2378

Cited by 63 publications

(17 citation statements)

References 26 publications

(12 reference statements)

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“…Finally, we decided to include patients admitted after heart surgery in the case mix, since those patients are taken into account in the SAPS 3 admission score. In addition, previous studies showed that performance of the APACHE II and SAPS II is adequate in case mix of patients admitted to the ICU after heart surgery [12]. Additional information on exclusion criteria may be found in the electronic supplementary material (ESM).…”

Section: Methodsmentioning

confidence: 99%

SAPS 3 admission score: an external validation in a general intensive care population

et al. 2008

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Objectives: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. Design: Cohort observational study. Setting: A 26-bed general ICU from a Tertiary University Hospital. Patients and participants: Eight hundred and fifty-one consecutive patients admitted to the ICU over an 8-month period. Of these patients, 49 were readmissions, leaving 802 patients for further analysis. Intervention: None. Measurements and results: APACHE II, SAPS II and SAPS 3 variables were prospectively collected; scores and their derived probability of death were calculated according to their original manuscript description. The discriminative power was assessed using the area under the ROC curve (AUROC) and calibration was verified with the Hosmer-Lemeshow goodness-of-fit test. The AUROC of the APACHE II model (AUROC = 0.823) was significantly lower than those of the SAPS II (AUROC = 0.850) and SAPS 3 models (AUROC = 0.854) (P = 0.038). The calibration of the APACHE II model (P = 0.037) and of the SAPS 3 global model (P = 0.035) appeared unsatisfactory. On the contrary, both SAPS II model and SAPS 3 model customised for Central and Western Europe had a good calibration. However, in our study case mix, SAPS II model tended to overestimate the probability of death. Conclusion: In this study, the SAPS 3 admission score and its prediction model customised for Central and Western Europe was more discriminative and better calibrated than APACHE II, but it was not significantly better than the SAPS II.

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Section: Methodsmentioning

confidence: 99%

SAPS 3 admission score: an external validation in a general intensive care population

et al. 2008

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“…Use of a single site is also a limitation because it can decrease the generalizability of the study findings. Inclusion of the APACHE II variable for the entire sample may also be a limitation, because the APACHE II is a poor prognostic indicator among cardiac surgery patients [47][48][49] ; consequently, we eliminated this variable from the main analysis.…”

Section: Limitationsmentioning

confidence: 99%

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Cox

Roche

2015

American Journal of Critical Care

112

103

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Background Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. Objective To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. Methods A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. Results Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. Conclusion The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.

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“…It must be noted that the risk scoring system used here was originally devised for assessment of operative mortality in acquired adult heart disease. 18 More recent evidence has identified the Parsonnet score as being among the best predictive systems not only for hospital mortality 26 but also for hospital morbidity after adult cardiac operations. 19 On the basis of the work of Lawrence and colleagues, 19 who demonstrated a direct correlation between Parsonnet score and prevalence of perioperative complications, a choice was made to condense the risk categories into low (1% to 5%) and high (Ͼ9%) risk and to stratify postoperative morbidity accordingly.…”

Section: I-256 Circulation September 18 2001mentioning

confidence: 99%

Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Luciani

Menon²,

Vecchi³

et al. 2001

Circulation

107

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Background-Extracorporeal circulation contributes to morbidity after open-heart surgery by causing a systemic inflammatory reaction. Modified ultrafiltration is a technique able to remove the fluid overload and inflammatory mediators associated with use of cardiopulmonary bypass. It has been shown to reduce morbidity after cardiac operations in children, but the impact on adult cardiac procedures is unknown. Methods and Results-Five hundred seventy-three consecutive adult patients were prospectively randomized to either ultrafiltration after cardiopulmonary bypass (treatment) or to no ultrafiltration (control). Parsonnet score was used to assess the severity of the patients' clinical conditions.

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Mortality Prediction in Cardiac Surgery Patients

Cited by 63 publications

References 26 publications

SAPS 3 admission score: an external validation in a general intensive care population

SAPS 3 admission score: an external validation in a general intensive care population

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

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