EuroSCORE as a Predictor for Complications and Outcome

Abstract

Objective: The purpose of this study was to evaluate the usefulness of EuroSCORE in terms of prediction of the outcome as a result of preoperative information in a cohort of patients. Methods: We analyzed the data from 751 patients treated between Jan 1 and Dec 31, 1998. We used contingency tables and applied methods of discriminant analysis for the evaluation. Results: Compared to the 14.799 patients from whose data the EuroSCORE system had originally been derived [1,2], we had a smaller portion of patients in the low-risk group (24.5 % vs. 30.6 %), a comparable portion of patients in the medium-risk group (42.2 % vs. 40.5 %) and a higher proportion of patients in the high-risk group (33.2 % vs. 29.0 %). This difference in the risk distributions was highly significant (p < 0.001). The application of the EuroSCORE system showed that deaths only occurred in the high-risk group in our hospital. We had 36 deaths amongst the patients, which gives an overall mortality rate of 4.9 % and a mortality rate of 1.6 % in the medium-risk group and of 12.4 % in the high-risk group. The discriminant analysis showed that with the EuroSCORE as single predicting variable - virtually all survivors were classified correctly (giving a specificity of 99.0 %). The sensitivity was rather low at only 25 %; however, this means that many of the high-risk patients in our clinic survived. The total misclassification rate, however, was 12.7 %. Additionally, we found that a higher score value predicts a significantly higher probability for perioperative complications and also results in significantly increased average times for the bypass and total time for surgery. Conclusion: The EuroSCORE is a valuable score system for the prediction of the overall outcome of patients following open heart surgery, and is easy to use. As far as perioperative complications are concerned, however, some specifications seem desirable.

Key words

Cardiac surgery - risk stratification - mortality - outcome

References

• 1 Roques F, Nashef P, Michel E, Gauducheau C, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones M T, Pinna Pintor P, Salomon R, Thulin L. Risk factors and outcome in European cardiac surgery: Analysis of the EuroSCORE multinational database of 19030 patients.  Eur J Cardio-Thorac Surgery. 1999;  15 816-823
• 2 Nashef S AM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. the EuroSCORE study group . European system for cardiac operative risk evaluation (EuroSCORE).  Eur J Cardio-Thorac Surgery. 1999;  16 9-13
• 3 Lefering R, Neugebauer E, Lechleuthner A, Troidl H. Asessment of critical care costs of intensive care unit with TISS (Therapeutic Intervention Scoring System)- an economic analysis of intensive care.  Langenbecks Arch Chir Suppl Kongressbd. 1996;  113 318-320
• 4 Clermont G, Angus D C, Linde-Zwirble W T, Lave J R, Pinsky M R. Measuring resource use in the ICU with computerized therapeutic intervention scoring system-based data.  Chest. 1998;  113 (2) 434-442
• 5 de Keizer N F, Bonsel G J, Goldfad C, Rowan K M. The added value that increasing levels of diagnostic information provide in prognostic models to estimate hospital mortality for adult intensive care patients.  Intensive Care Med. 2000;  26 (5) 577-584
• 6 Pierpont G L, Parenti C M. Physician risk assessment and APACHE scores in cardiac care units.  Clin Cardiol. 1999;  22 (5) 366-368
• 7 Teoh L S, Gowardman J R, Larsen P D, Green R, Galletly D C. Glasgow Coma Scale: variation in mortality among permutations of specific total scores.  Intensive Care Med. 2000;  26 (2) 157-161
• 8 Reina A, Vasquez G, Aguayo E, Bravo I, Colmenero M, Bravo M. Mortality discrimination in acute myocardial infarction: comparison between APACHE III and SAPS II prognosis systems.  Intensive Care Med. 1997;  23 (3) 326-330
• 9 Markgraf R, Deutschinoff G, Pientka L, Scholten T. Comparison of acute physiology and chronic health evaluations II and III and simplified acute physiology score II: a prospective cohort study evaluating these methods to predict outcome in a german interdisciplinary intensive care unit.  Crit Care Med. 2000;  28 (I) 26-33
• 10 Schuster P, Schuster F P, Ritschel P, Wilts S, Bodmann K F. The ability of the Simplified Acute Physiology Score (SAPS II) to predict outcome in coronary care patients.  Intensive Care Med. 1997;  23 (10) 1056-1061
• 11 Schuster H P, Wilts S, Ritschel P, Schuster F P. Predictive value of score parameters of the Simplified Acute Physiology Score (SAPS)-II for the duration of treatment of intensive care patients.  Wien Klin Wochenschr. 1996;  108 (15) 462-466
• 12 Gabrielle F, Roques F, Michel P, Bernard A, de Vicentis C, Roques X, Brenot R, Baudet E, David M. Is the Parsonnet's score a good predictive score of mortality in adult cardiac surgery: assessment by a French multicenter study.  Eur J Cardio Thorac Surg. 1997;  11 (3) 406-414
• 13 Wynne-Jones K, Jackson M, Grotte G, Bridgewater B. Limitations of the Parsonnet score for measuring in the north west of England.  Heart. 2000;  84 (I) 71-78