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Thorac Cardiovasc Surg 2014; 62(04): 288-297
DOI: 10.1055/s-0034-1367734
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Clinical Performance of the EuroSCORE II Compared with the Previous EuroSCORE Iterations

Lazar Velicki
1   Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
2   Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
,
Nada Cemerlic-Adjic
1   Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
2   Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
,
Katica Pavlovic
1   Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
2   Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
,
Bojan B. Mihajlovic
2   Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
,
Dragic Bankovic
3   Department of Mathematics, State University of Novi Pazar, Novi Pazar, Serbia
,
Bogoljub Mihajlovic
1   Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
2   Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
,
Miklos Fabri
2   Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
› Author Affiliations
Further Information

Publication History

28 August 2013

30 November 2013

Publication Date:
21 April 2014 (online)

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Abstract

Background The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II has been recently introduced as an update to the previous versions. We sought to evaluate the predictive performance of the EuroSCORE II model against the original additive and logistic EuroSCORE models.

Patients and Methods The study included 1,247 consecutive patients who underwent cardiac surgery procedures during a 14-month period starting from the beginning of 2012. The original additive and logistic EuroSCORE models were compared with the EuroSCORE II focusing on the accuracy of predicting hospital mortality.

Results The overall hospital mortality rate was 3.45%. The discriminative power of the EuroSCORE II was modest and similar to other algorithms (C-statistics 0.754 for additive EuroSCORE; 0.759 for logistic EuroSCORE; and 0.743 for EuroSCORE II). The EuroSCORE II significantly underestimated the all-patient hospital mortality (3.45% observed vs. 2.12% predicted), as well as in the valvular (3.74% observed vs. 2% predicted), and combined surgery cohorts (6.87% observed vs. 3.64% predicted). The predicted EuroSCORE mortality significantly differed from the observed mortality in the third and the fourth quartile of patients stratified according to the EuroSCORE II mortality risk (p < 0.05). The calibration of the EuroSCORE II was generally good for the entire patient population (Hosmer-Lemeshow [HL] p = 0.139), for the valvular surgery subset (HL p = 0.485), and for the combined surgery subset (HL p = 0.639).

Conclusion The EuroSCORE II might be considered a solid predictive tool for hospital mortality. Although, the EuroSCORE II employs more sophisticated calculation methods regarding the number and definition of risk factors included, it does not seem to significantly improve the performance of previous iterations.

Keywords

cardiac surgery - risk assessment - EuroSCORE - outcome - mortality - prediction

Note

This paper was supported by the Provincial Secretariat for Science and Technological Development of the Autonomous Province of Vojvodina (Serbia) (Grant number 114–451–2131/2011).