Department of Cardiothoracic Surgery, University Hospital Birmingham-Queen Elizabeth, Birmingham, UK.
Eur J Cardiothorac Surg. 2013 Dec;44(6):1006-11; discussion 1011. doi: 10.1093/ejcts/ezt174. Epub 2013 Mar 27.
Prediction of operative risk in adult patients undergoing cardiac surgery remains a challenge, particularly in high-risk patients. In Europe, the EuroSCORE is the most commonly used risk-prediction model, but is no longer accurately calibrated to be used in contemporary practice. The new EuroSCORE II was recently published in an attempt to improve risk prediction. We sought to assess the predictive value of EuroSCORE II compared with the original EuroSCOREs in high-risk patients.
Patients who underwent surgery between 1 April 2006 and 31 March 2011 with a preoperative logistic EuroSCORE ≥ 10 were identified from prospective cardiac surgical databases at two European institutions. Additional variables included in EuroSCORE II, but not in the original EuroSCORE, were retrospectively collected through patient chart review. The C-statistic to predict in-hospital mortality was calculated for the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II models. The Hosmer-Lemeshow test was used to assess model calibration by comparing observed and expected mortality in a number of risk strata. The fit of EuroSCORE II was compared with the original EuroSCOREs using Akaike's Information Criterion (AIC).
A total of 933 patients were identified; the median additive EuroSCORE was 10 (interquartile range [IQR] 9-11), median logistic EuroSCORE 15.3 (IQR 12.0-24.1) and median EuroSCORE II 9.3 (5.8-15.6). There were 90 (9.7%) in-hospital deaths. None of the EuroSCORE models performed well with a C-statistic of 0.67 for the additive EuroSCORE and EuroSCORE II, and 0.66 for the logistic EuroSCORE. Model calibration was poor for the EuroSCORE II (chi-square 16.5; P = 0.035). Both the additive EuroSCORE and logistic EuroSCORE had a numerically better model fit, the additive EuroSCORE statistically significantly so (difference in AIC was -5.66; P = 0.017).
The new EuroSCORE II does not improve risk prediction in high-risk patients undergoing adult cardiac surgery when compared with original additive and logistic EuroSCOREs. The key problem of risk stratification in high-risk patients has not been addressed by this new model. Future iterations of the score should explore more advanced statistical methods and focus on developing procedure-specific algorithms. Moreover, models that predict complications in addition to mortality may prove to be of increasing value.
预测成人心脏手术患者的手术风险仍然是一个挑战，尤其是对于高危患者。在欧洲，EuroSCORE 是最常用的风险预测模型，但它已不再能准确地校准以适用于现代实践。最近公布了新的 EuroSCORE II，旨在改进风险预测。我们试图评估 EuroSCORE II 与原始 EuroSCORE 在高危患者中的预测价值。
从欧洲两个机构的前瞻性心脏外科数据库中，确定了 2006 年 4 月 1 日至 2011 年 3 月 31 日期间手术前术前逻辑 EuroSCORE≥10 的患者。通过回顾性病历检查，收集了 EuroSCORE II 中包含但原始 EuroSCORE 中不包含的其他变量。计算了加性 EuroSCORE、逻辑 EuroSCORE 和 EuroSCORE II 模型预测住院死亡率的 C 统计量。通过比较多个风险分层中观察到的和预期的死亡率，Hosmer-Lemeshow 检验用于评估模型校准。使用赤池信息量准则 (AIC) 比较 EuroSCORE II 与原始 EuroSCORE 的拟合度。
共确定了 933 例患者；中位加性 EuroSCORE 为 10（四分位距 [IQR] 9-11），中位逻辑 EuroSCORE 为 15.3（IQR 12.0-24.1），中位 EuroSCORE II 为 9.3（5.8-15.6）。有 90 例（9.7%）院内死亡。加性 EuroSCORE 和 EuroSCORE II 的 C 统计量为 0.67，逻辑 EuroSCORE 的 C 统计量为 0.66，这三种 EuroSCORE 模型的表现均不佳。EuroSCORE II 的模型校准效果较差（卡方检验为 16.5；P=0.035）。加性 EuroSCORE 和逻辑 EuroSCORE 的模型拟合度均有所提高，加性 EuroSCORE 的提高具有统计学意义（AIC 差值为-5.66；P=0.017）。
与原始加性和逻辑 EuroSCORE 相比，新的 EuroSCORE II 并不能改善高危成人心脏手术患者的风险预测。该新模型并未解决高危患者风险分层的关键问题。该评分的未来迭代应探索更先进的统计方法，并专注于开发特定于手术的算法。此外，预测死亡率以外并发症的模型可能会被证明具有越来越大的价值。
