The new EuroSCORE II does not improve prediction of mortality in high-risk patients undergoing cardiac surgery: a collaborative analysis of two European centres

Howell, Neil; Head, Stuart J.; Freemantle, Nick; Meulen, Taco A. van der; Senanayake, Eshan; Menon, Ashvini; Kappetein, Arie Pieter; Pagano, Domenico

doi:10.1093/ejcts/ezt174

Cited by 67 publications

(51 citation statements)

References 24 publications

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“…An additional limitation of the EuroSCORE is its overestimation of mortality, particularly with higher scores. 1,29 Seventh, a new version of the EuroSCORE (II) was proposed after completing enrollment. 26 We had information on the variables that were newly included in the model with the exception of pulmonary arterial pressure, which was collected as pulmonary hypertension (>60 mm Hg) instead of the categories (31-55 mm Hg and >55 mm Hg) as per the EuroSCORE II.…”

Section: Strength and Limitationsmentioning

confidence: 99%

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

et al. 2014

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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...

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Section: Strength and Limitationsmentioning

confidence: 99%

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

et al. 2014

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“…The recently published EuroSCORE II [1] refreshed our 17 knowledge of adult cardiac surgical risk and gave us an …”

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confidence: 99%

Performance of EuroSCORE II in Hungary: A Single-centre Validation Study

Koszta

Sira

Szatmári

et al. 2014

Heart, Lung and Circulation

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“…In another study from Italy (a total of 1090 patients) the accuracy of ESII was also not significantly higher than other scores (logES: AUC 0.79; ESII: AUC 0.81) [8]. The same tendency appeared also in the study of two European centres in Birmingham and Rotterdam on a group of 933 patients [16].…”

Section: Discriminatory Powermentioning

confidence: 56%

“…The outcomes of other studies were not unanimous. Higher results for logES were obtained only in two reports from European institutions with p-values ranging from 0.30 [8] to 0.45 [16]. It is interesting that only in one of the newest performed studies, ESII demonstrated tolerable calibration (p = 0.12) [8].…”

Section: Discriminatory Powermentioning

confidence: 79%

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

et al. 2016

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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

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The new EuroSCORE II does not improve prediction of mortality in high-risk patients undergoing cardiac surgery: a collaborative analysis of two European centres

Cited by 67 publications

References 24 publications

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

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

Performance of EuroSCORE II in Hungary: A Single-centre Validation Study

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

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