Validation of EuroSCORE II to predict mortality in post-cardiac surgery patients in East Java tertiary hospital

  • Yan Efrata Sembiring Department of Thoracic Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia https://orcid.org/0000-0002-1712-1816
  • Adhitya Ginting Department of Thoracic Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia https://orcid.org/0000-0002-6341-5567
  • Puruhito Department of Thoracic Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
  • Budiono Department of Public Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0002-0969-901X
Keywords: cardiac surgery, mortality, prognosis, treatment outcome
Abstract viewed: 373 times
PDF downloaded: 264 times
HTML downloaded: 54 times
EPUB downloaded: 71 times

Abstract

BACKGROUND The European system for cardiac operative risk evaluation (EuroSCORE) II is one of the established risk models used to predict mortality after cardiac surgery. However, its application as a mortality predictor for Indonesian adult cardiac surgery is still unknown. This study aimed to examine the validation of EuroSCORE II in predicting the mortality following adult cardiac surgery in Indonesian adults.

METHODS This retrospective cohort study collected data from the medical records and the database of the Department of Thoracic Cardiac and Vascular Surgery at Soetomo General Hospital, Surabaya. Data on the EuroSCORE II variables were collected for patients aged >18 years who underwent coronary artery bypass, heart valve, heart tumors, aortic surgeries, or a combination of these surgeries between January 2016 and December 2018. In-hospital mortality prediction was calculated using the online calculator at www.euroscore.org. The calibration of the EuroSCORE II model was conducted using the Hosmer–Lemeshow test, and discrimination analysis was done using receiver operating characteristic (ROC) curves with area under the ROC curve (AUC) calculation.

RESULTS A total of 213 patients met the inclusion criteria and were analyzed for this study. Mortality was 8.9%. The predicted and actual mortalities were 1.74% and 8.9%, respectively. The significance (p-value) of the Hosmer–Lemeshow test was 0.55, indicating good calibration. The AUC of ROC curve was 0.85 (95% CI = 0.77–0.92, p<0.001), suggesting good discrimination.

CONCLUSIONS EuroSCORE II has a good calibration and discrimination for cardiac surgery in Indonesian adults.

References

  1. Peterson ED. Innovation and comparative-effectiveness research in cardiac surgery. N Engl J Med. 2009;361(19):1897-9. https://doi.org/10.1056/NEJMe0907887

  2. Prins C, Jonker ID, Smit FE, Botes L. Cardiac surgery risk-stratification models. Cardiovasc J Afr. 2012;23(3):160-4. https://doi.org/10.5830/CVJA-2011-047

  3. Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in cardiac surgery patients. Ann Thorac Surg. 2016;102(2):573-9. https://doi.org/10.1016/j.athoracsur.2016.01.105

  4. Siregar S, Groenwold RH, de Heer F, Bots ML, van der Graaf Y, van Herwerden LA. Performance of the original EuroSCORE. Eur J Cardiothorac Surg. 2012;41(4):746-54. https://doi.org/10.1093/ejcts/ezr285

  5. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-44; discussion 744-5. https://doi.org/10.1093/ejcts/ezs043

  6. Bai Y, Wang L, Guo Z, Chen Q, Jiang N, Dai J, et al. Performance of EuroSCORE II and SinoSCORE in Chinese patients undergoing coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2016;23(5):733-9. https://doi.org/10.1093/icvts/ivw224

  7. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):e21-181. https://doi.org/10.1161/CIRCULATIONAHA.108.191259

  8. Stavridis G, Panaretos D, Kadda O, Panagiotakos DB. Validation of the EuroSCORE II in a Greek cardiac surgical population: a prospective study. Open Cardiovasc Med J. 2017;11:94-101. https://doi.org/10.2174/1874192401711010094

  9. Kar P, Geeta K, Gopinath R, Durga P. Mortality prediction in Indian cardiac surgery patients: validation of European System for Cardiac Operative Risk Evaluation II. Indian J Anaesth. 2017;61(2):157-62. https://doi.org/10.4103/ija.IJA_522_16

  10. Garcia-Valentin A, Mestres CA, Bernabeu E, Bahamonde JA, Martín I, Rueda C, et al. Validation and quality measurements for EuroSCORE and EuroSCORE II in the Spanish cardiac surgical population: a prospective, multicentre study. Eur J Cardiothorac Surg. 2016;49(2):399-405. https://doi.org/10.1093/ejcts/ezv090

  11. Zhang GX, Wang C, Wang L, Lu FL, Li BL, Han L, et al. Validation of EuroSCORE II in Chinese patients undergoing heart valve surgery. Heart Lung Circ. 2013;22(8):606-11. https://doi.org/10.1016/j.hlc.2012.12.012

  12. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: a systematic review of international performance. Eur J Cardiothorac Surg. 2004;25(5):695-700. https://doi.org/10.1016/j.ejcts.2004.02.022

  13. Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJ, et al. Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ. 2003;327(7405):13-7. https://doi.org/10.1136/bmj.327.7405.13

  14. Axelsson TA, Mennander A, Malmberg M, Gunn J, Jeppsson A, Gudbjartsson T. Is emergency and salvage coronary artery bypass grafting justified? The Nordic Emergency/Salvage coronary artery bypass grafting study. Eur J Cardiothorac Surg. 2016;49(5):1451-6. https://doi.org/10.1093/ejcts/ezv388

Published
2021-03-31
How to Cite
1.
Sembiring YE, Ginting A, Puruhito, Budiono. Validation of EuroSCORE II to predict mortality in post-cardiac surgery patients in East Java tertiary hospital. Med J Indones [Internet]. 2021Mar.31 [cited 2021Oct.26];30(1):54-9. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/4536
Section
Clinical Research