Thorac Cardiovasc Surg 2010; 58(7): 392-397
DOI: 10.1055/s-0030-1250080
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Prognostic Value of Daily Cardiac Surgery Score (CASUS) and its Derivatives in Cardiac Surgery Patients

A. M. A. Badreldin1 , A. Kroener2 , M. B. Heldwein1 , F. Doerr1 , H. Vogt1 , M. M. Ismail1 , T. Bossert1 , K. Hekmat1
  • 1Department of Cardiothoracic Surgery, Friedrich Schiller University Hospital of Jena, Jena, Germany
  • 2Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
Further Information

Publication History

received February 19, 2010

Publication Date:
04 October 2010 (online)

Abstract

Background: We aimed to validate the usefulness of CASUS derivatives for cardiac surgery patients and their reliability for daily decision making. Methods: We included, prospectively, the data of all adult cardiac surgery patients who had an ICU stay of at least 12 hours between 20 January 2003 and 14 October 2005 in the Department of Cardiothoracic Surgery of the University of Cologne, Germany. Data were collected until ICU discharge and included initial, maximum, mean, and total CASUS values. δ CASUS (difference from initial value) was calculated at 48 and 96 hours postoperatively. The predictive efficacy of the derivatives was tested with calibration and discrimination statistics. Results: 2372 patients were included with a mean age of 66.2 ± 11.2 years. ICU mortality was 3.6 % (n = 85). Mean ICU stay was 3.0 ± 6.1 days. The discrimination was very good for all derivatives (area under the curve ranged between 0.988 and 0.926). The calibration was also good except for the total CASUS, which showed a significant difference between the expected and observed mortality. Increased δ CASUS at 48 hours (1038 patients) and 96 hours (435 patients) correlated with an increase in mortality (23.1 % and 42.9 %, respectively), and conversely a decreased mortality rate was observed with decreasing values (1.9 % and 3.8 %, respectively). Conclusion: CASUS derivatives including δ CASUS have a good prognostic value for cardiac surgery patients with regard to the prediction of mortality and survival during ICU stay, with the exception of total CASUS which was not informative.

References

  • 1 Hekmat K, Kroener A, Stuetzer H, Schwinger R H, Kampe S, Bennink G B, Mehlhorn U. Daily assessment of organ dysfunction and survival in intensive care unit cardiac surgical patients.  Ann Thorac Surg. 2005;  79 1555-1562
  • 2 Ferreira F L, Bota D P, Bross A, Melot C, Vincent J L. Serial evaluation of the SOFA score to predict outcome in critically ill patients.  JAMA. 2001;  286 1754-1758
  • 3 Khwannimit B. Serial evaluation of the MODS, SOFA and LOD scores to predict ICU mortality in mixed critically ill patients.  J Med Assoc Thai. 2008;  91 (9) 1336-1342
  • 4 Kramer A A, Zimmerman J E. Predicting outcome for cardiac surgery patients after intensive care unit admission.  Semin Cardiothorac Vasc Anesth. 2008;  12 (3) 175-183
  • 5 Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review.  Crit Care. 2008;  12 (6) R161
  • 6 Zimmerman J E, Wagner D P, Seneff M G, Becker R B, Sun X, Knaus W A. Intensive care unit admissions with cirrhosis: risk-stratifying patient groups and predicting individual survival.  Hepatology. 1996;  23 (6) 1393-1401
  • 7 Fleegler B M, Jackson D K, Turnbull J, Honeycutt C, Azola C, Sirio C A. Identifying potentially ineffective care in a community hospital.  Crit Care Med. 2002;  30 (8) 1803-1807
  • 8 Suter P, Armaganidis A, Beaufils F, Bonfill X, Burchardi H, Cook D, Fagot-Largeault A, Thijs L, Vesconi S, Williams A, LeGall J R, Chang R. 2nd European Consensus Conference in Intensive Care Medicine: predicting outcome in ICU patients.  Intensive Care Med. 1994;  20 390-397
  • 9 Knaus W A, Draper E A, Wagner D P, Zimmerman J E. APACHE II: a severity of disease classification system.  Crit Care Med. 1985;  13 818-829
  • 10 Ryan T A, Rady M Y, Bashour C A, Leventhal M, Lytle B, Starr N J. Predictors of outcome in cardiac surgical patients with prolonged intensive care stay.  Chest. 1997;  112 1035-1042
  • 11 Turner J S, Morgan C J, Thakrar B, Pepper J R. Difficulties in predicting outcome in cardiac surgery patients.  Crit Care Med. 1995;  23 1843-1850
  • 12 Higgins T L, Estafanous F G, Loop F D, Beck G J, Lee J C, Starr N J, Knaus W A, Cosgrove 3rd D M. ICU admission score for predicting morbidity and mortality risk after coronary artery bypass grafting.  Ann Thorac Surg. 1997;  64 1050-1058
  • 13 Marshall J C, Cook D J, Christou N V, Bernard G R, Sprung C L, Sibbald W J. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.  Crit Care Med. 1995;  23 1638-1652
  • 14 Marik P E, Varon J. Severity scoring and outcome assessment. Computerized predictive models and scoring systems.  Crit Care Clin. 1999;  15 633-646
  • 15 Bosman R J, Oudemane van Straaten H M, Zandstra D F. The use of intensive care information systems alters outcome prediction.  Intensive Care Med. 1998;  24 953-958
  • 16 Ceriani R, Mazzoni M, Bortone F, Gandini S, Solinas C, Susini G, Parodi O. Application of the sequential organ failure assessment score to cardiac surgical patients.  Chest. 2003;  123 1229-1239
  • 17 Moreno R, Vincent J L, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis Related Problems of the ESICM.  Intensive Care Med. 1999;  25 686-696
  • 18 Peres Bota D, Melot C, Lopes Ferreira F, Nguyen Ba V, Vincent J L. The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction.  Intensive Care Med. 2002;  28 1619-1624
  • 19 Pettilä V, Pettilä M, Sarna S, Voutilainen P, Takkunen O. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill.  Crit Care Med. 2002;  30 (8) 1705-1711
  • 20 Zygun D A, Laupland K B, Fick G H, Sandham J D, Doig C J. Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1436 patients.  Can J Anaesth. 2005;  52 302-308
  • 21 Janssens U, Graf C, Graf J, Radke P W, Konigs B, Koch K C, Lepper W, vom Dahl J, Hanrath P. Evaluation of the SOFA score: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders. Sequential Organ Failure Assessment.  Intensive Care Med. 2000;  26 1037-1045

Dr. Akmal M.A. Badreldin, MD, PhD

Department of Cardiothoracic Surgery
Friedrich Schiller University Hospital of Jena

Erlanger Allee 101

07747 Jena

Germany

Phone: +49 3 64 19 32 29 84

Fax: +49 3 64 19 32 29 02

Email: akmalbadreldin@yahoo.com