HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marco Ranucci Lorenzo A. Menicanti Sabino Scolletta Pierpaolo Giomarelli Permission Requests Citing Articles Citing Articles via HighWire Google Scholar Articles by Ranucci, M. Articles by Giomarelli, P. PubMed Articles by Ranucci, M. Articles by Giomarelli, P. Related Collections Cardiac - other

An adjusted EuroSCORE model for high-risk cardiac patients

^a Department of Cardiothoracic – Vascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy
^b Department of Surgery and Bioengineering, Unit of Cardiothoracic Surgery, University of Siena, Italy

Received 6 November 2008; received in revised form 8 February 2009; accepted 9 February 2009.

^_* Corresponding author. Address: Department of Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy. Tel.: +39 02 52774320; fax: +39 02 55602262. (Email: cardioanestesia{at}virgilio.it).

Objective: To verify the accuracy and precision of the logistic European system for cardiac operative risk evaluation (EuroSCORE) in high-risk cardiac surgery patients and to develop and externally validate a new system of recalibration. Methods: The development series included 4279 high-risk patients who had undergone cardiac operations at the IRCCS Policlinico S. Donato. Performance, accuracy, and precision of the logistic EuroSCORE were assessed in this series, using a deciles-based comparison between expected and observed mortality rates, a receiver operating characteristic analysis, and a Hosmer–Lemeshow test for calibration. Differences between predicted and observed mortality rates were mathematically evaluated to develop an adjusted logistic EuroSCORE. This adjusted risk score was subsequently validated with the same approach on an external series of 1459 high-risk patients who had undergone cardiac operations at the Siena hospital. Results: The adjusted logistic EuroSCORE was based on five different correction factors applied to the crude logistic EuroSCORE depending on its value. At the external validation, this model provided a good performance, with observed mortality rates not significantly different from the expected in 8 out of 10 deciles of risk distribution. The adjusted EuroSCORE had the same moderate balanced accuracy of the crude logistic EuroSCORE (area under the curve: 0.695), with a better precision (Hosmer–Lemeshow calibration test: ²: 3.6, p = 0.891). Conclusions: Recalibration of the logistic EuroSCORE in high-risk patients is needed due to its tendency to overestimate the mortality risk. The application of a variable correction factor results in a better performance, increased precision, with unaltered balanced accuracy.

Key Words: Risk-adjustment • EuroSCORE • Logistic model • Cardiac surgery

This article has been cited by other articles:

				E. Manasse Cooks and recipes Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 787 - 790. [Full Text] [PDF]

				T. M. Dewey and M. A. Herbert Editorial comment: Predicting operative risk: a worthy task -- an elusive goal Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 797 - 798. [Full Text] [PDF]