Department of Cardiothoracic Surgery, University of Manchester, Manchester Academic Health Science, Centre, University Hospital of South Manchester, Manchester, UK.
Heart. 2012 Nov;98(21):1568-72. doi: 10.1136/heartjnl-2012-302483. Epub 2012 Aug 21.
The original EuroSCORE models are poorly calibrated for predicting mortality in contemporary cardiac surgery. EuroSCORE II has been proposed as a new risk model. The objective of this study was to assess the performance of EuroSCORE II in UK cardiac surgery.
A cross-sectional analysis of prospectively collected multi-centre clinical audit data, from the Society for Cardiothoracic Surgery in Great Britain and Ireland Database.
All NHS hospitals, and some UK private hospitals performing adult cardiac surgery.
23 740 procedures at 41 hospitals between July 2010 and March 2011.
The main outcome measure was in-hospital mortality. Model calibration (Hosmer-Lemeshow test, calibration plot) and discrimination (area under receiver operating characteristic curve) were assessed in the overall cohort and clinically defined sub-groups.
The mean age at procedure was 67.1 years (SD 11.8) and 27.7% were women. The overall mortality was 3.1% with a EuroSCORE II predicted mortality of 3.4%. Calibration was good overall but the model failed the Hosmer-Lemeshow test (p=0.003) mainly due to over-prediction in the highest and lowest-risk patients. Calibration was poor for isolated coronary artery bypass graft surgery (Hosmer-Lemeshow, p<0.001). The model had good discrimination overall (area under receiver operating characteristic curve 0.808, 95% CI 0.793 to 0.824) and in all clinical sub-groups analysed.
EuroSCORE II performs well overall in the UK and is an acceptable contemporary generic cardiac surgery risk model. However, the model is poorly calibrated for isolated coronary artery bypass graft surgery and in both the highest and lowest risk patients. Regular revalidation of EuroSCORE II will be needed to identify calibration drift or clinical inconsistencies, which commonly emerge in clinical prediction models.
原始的 EuroSCORE 模型在预测当代心脏外科死亡率方面的校准效果不佳。EuroSCORE II 已被提出作为一种新的风险模型。本研究的目的是评估 EuroSCORE II 在英国心脏外科中的表现。
对来自英国胸外科医师学会数据库的前瞻性收集的多中心临床审计数据进行的横断面分析。
英国国民保健制度医院和一些进行成人心脏手术的英国私立医院。
2010 年 7 月至 2011 年 3 月期间在 41 家医院进行的 23740 例手术。
主要观察指标为院内死亡率。在整个队列和临床定义的亚组中评估了模型校准（Hosmer-Lemeshow 检验，校准图）和区分度（接收者操作特征曲线下面积）。
手术时的平均年龄为 67.1 岁（标准差 11.8），27.7%为女性。整体死亡率为 3.1%，EuroSCORE II 预测死亡率为 3.4%。总体校准效果良好，但该模型未能通过 Hosmer-Lemeshow 检验（p=0.003），主要是由于高危和低危患者的预测值偏高。EuroSCORE II 对单纯冠状动脉旁路移植术的校准效果不佳（Hosmer-Lemeshow，p<0.001）。该模型在整体和所有分析的临床亚组中均具有良好的区分度（接受者操作特征曲线下面积 0.808，95%CI 0.793 至 0.824）。
EuroSCORE II 在英国总体表现良好，是一种可接受的当代通用心脏外科风险模型。然而，该模型对单纯冠状动脉旁路移植术的校准效果不佳，并且在高危和低危患者中均如此。需要定期对 EuroSCORE II 进行重新验证，以识别校准漂移或临床不一致性，这些问题通常出现在临床预测模型中。
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