Division of Cardio-Thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland,
World J Surg. 2010 Dec;34(12):2979-84. doi: 10.1007/s00268-010-0775-y.
EuroSCORE is an adult cardiac surgery risk scoring method that is used worldwide, which has been shown to significantly overestimate the operative risk. We derived a new risk scoring method by modifying some of the risk factors included in the EuroSCORE algorithm and we validated it in an external database.
This study included 4,014 patients who underwent adult cardiac surgery at the Heart Centre, Tampere University Hospital, Finland. Operative risk was estimated by EuroSCORE and its modified version.
In-hospital postoperative mortality rate was 3.2%. EuroSCORE (AUC for logistic EuroSCORE 0.82; 95% confidence interval (CI), 0.79-0.85) and modified score (AUC for logistic modified score 0.79; 95% CI, 0.75-0.83) performed well in predicting in-hospital mortality in this series. The mean logistic EuroSCORE was 8%, and the mean logistic modified score was 2.2%. Thus, the observed to expected ratio for in-hospital mortality was 0.4 for logistic EuroSCORE and 1.5 for logistic modified score. The difference between observed and predicted mortality rate matched correctly for increasing additive modified score, but not for EuroSCORE. The observed to predicted ratio in high-risk patients (within the 90th percentile of each risk algorithm) was 0.36 (13.2%/36.2% in 402 patients) for logistic EuroSCORE and 0.99 (14.7%/14.9% in 395 patients) for logistic modified score.
This modified and simplified score, which includes most of EuroSCORE variables, seems to provide a more realistic estimation of postoperative mortality risk of patients undergoing any adult cardiac surgery.
EuroSCORE 是一种成人心脏手术风险评分方法，在全球范围内使用，已被证明严重高估了手术风险。我们通过修改 EuroSCORE 算法中包含的一些风险因素，得出了一种新的风险评分方法，并在外部数据库中进行了验证。
这项研究纳入了在芬兰坦佩雷大学医院心脏中心接受成人心脏手术的 4014 名患者。手术风险由 EuroSCORE 和其改良版进行评估。
住院期间的术后死亡率为 3.2%。EuroSCORE（逻辑 EuroSCORE 的 AUC 为 0.82；95%置信区间（CI）为 0.79-0.85）和改良评分（逻辑改良评分的 AUC 为 0.79；95%CI 为 0.75-0.83）在本系列中对预测住院死亡率表现良好。平均逻辑 EuroSCORE 为 8%，平均逻辑改良评分 2.2%。因此，住院死亡率的观察与预期比值为逻辑 EuroSCORE 的 0.4，逻辑改良评分的 1.5。对于递增的附加改良评分，观察到的与预测的死亡率差异匹配良好，但对于 EuroSCORE 则不然。在高风险患者（每个风险算法的第 90 个百分位数内）中，逻辑 EuroSCORE 的观察到的与预测的比值为 0.36（402 例患者中的 13.2%/36.2%），逻辑改良评分的观察到的与预测的比值为 0.99（395 例患者中的 14.7%/14.9%）。
这种改良和简化的评分方法包含了大多数 EuroSCORE 变量，似乎能够更真实地估计接受任何成人心脏手术的患者的术后死亡风险。
