Implementation of EuroSCORE II as an adjunct to APACHE II model and SOFA score, for refining the prognostic accuracy in cardiac surgical patients.

AIM

The aim of this paper was to assess the comparable applicability of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure (SOFA) scores, in cardiac surgical population, on the basis of morbidity and mortality.

METHODS

EuroSCORE II, APACHE II score and SOFA score derivatives such as TMS (total maximum SOFA), MaxSOFA (single-day maximum total), SOFA 1 (admission SOFA), ΔSOFA (TMS minus SOFA 1), ΔmaxSOFA (MaxSOFA minus SOFA 1) and mean SOFA (daily SOFA to ICU stay), were prospectively calculated for 1058 consecutive patients admitted to postcardiac surgery intensive care unit (ICU). The study endpoints were length of ICU stay (LOS-ICU) and hospital mortality.

RESULTS

A disproportionate elevation of the studied algorithms was associated with prolonged LOS-ICU (P<0.001). TMS, MeanSOFA, MaxSOFA and EuroSCORE II provided better discrimination for in-hospital death [area under the receiver operating characteristic curve (AUC) 0.949, 0.929, 0.927 and 0.906, respectively] and LOS-ICU more than 2 days (AUC 0.853, 0.823, 0.819 and 0.806, respectively), compared to other risk models. EuroSCORE II, TMS and MeanSOFA were also identified as independent predictors of prolonged LOS-ICU.

CONCLUSION

EuroSCORE II seems to confer noteworthy prognostic value, being almost equivalent to that of TMS, MeanSOFA and MaxSOFA scores, and superior than APACHE II in cardiac surgical population. Thus, EuroSCORE II emerges as an imperative adjunct to ICU-based APACHE II and SOFA algorithms as it enables risk stratification, morbidity and mortality prediction even from preoperative assessment.