Validation of the European System for Cardiac Operative Risk Evaluation-II Model in an Urban Indian Population and Comparison with Three Other Risk Scoring Systems

Overview

Journal Ann Card Anaesth

Specialty Anesthesiology

Date 2015 Jul 4

PMID 26139738

Citations 6

Authors

Biju Sivam Pillai

Kanwar Aditya Baloria

Nandini Selot

Affiliations

Soon will be listed here.

Abstract

Aims And Objectives: The aims were to compare the European System for Cardiac Operative Risk Evaluation (EuroSCORE)-II system against three established risk scoring systems for predictive accuracy in an urban Indian population and suggest improvements or amendments in the existing scoring system for adaptation in Indian population.

Materials And Methods: EuroSCORE-II, Parsonnet score, System-97 score, and Cleveland score were obtained preoperatively for 1098 consecutive patients. EuroSCORE-II system was analyzed in comparison to each of the above three scoring systems in an urban Indian population. Calibrations of scoring systems were assessed using Hosmer-Lemeshow test. Areas under receiver operating characteristics (ROC) curves were compared according to the statistical approach suggested by Hanley and McNeil.

Results: All EuroSCORE-II subgroups had highly significant P values stating good predictive mortality, except high-risk group (P = 0.175). The analysis of ROC curves of different scoring systems showed that the highest predictive value for mortality was calculated for the System-97 score followed by the Cleveland score. System-97 revealed extremely high predictive accuracies across all subgroups (curve area >80%). This difference in predictive accuracy was found to be statistically significant (P < 0.001).

Conclusions: The present study suggests that the EuroSCORE-II model in its present form is not validated for use in the Indian population. An interesting observation was significantly accurate predictive abilities of the System-97 score.

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References

Roques F, Nashef S, Michel P, Gauducheau E, De Vincentiis C, Baudet E . Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999; 15(6):816-22; discussion 822-3. DOI: 10.1016/s1010-7940(99)00106-2. View

Ferraris V, Ferraris S . Risk factors for postoperative morbidity. J Thorac Cardiovasc Surg. 1996; 111(4):731-38;discussion 738-41. DOI: 10.1016/s0022-5223(96)70333-1. View

Borde D, Gandhe U, Hargave N, Pandey K, Khullar V . The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery. Ann Card Anaesth. 2013; 16(3):163-6. DOI: 10.4103/0971-9784.114234. View

Harrell Jr F, Lee K, Mark D . Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996; 15(4):361-87. DOI: 10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4. View

Green J, Wintfeld N . How accurate are hospital discharge data for evaluating effectiveness of care?. Med Care. 1993; 31(8):719-31. DOI: 10.1097/00005650-199308000-00005. View

Malik M, Chauhan S, Malik V, Gharde P, Kiran U, Pandey R . Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?. Ann Card Anaesth. 2010; 13(3):241-5. DOI: 10.4103/0971-9784.69082. View

Ferguson Jr T, Dziuban Jr S, EDWARDS F, Eiken M, Shroyer A, Pairolero P . The STS National Database: current changes and challenges for the new millennium. Committee to Establish a National Database in Cardiothoracic Surgery, The Society of Thoracic Surgeons. Ann Thorac Surg. 2000; 69(3):680-91. DOI: 10.1016/s0003-4975(99)01538-6. View

Jollis J, Ancukiewicz M, DeLong E, Pryor D, Muhlbaier L, Mark D . Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research. Ann Intern Med. 1993; 119(8):844-50. DOI: 10.7326/0003-4819-119-8-199310150-00011. View

Iezzoni L . Risk adjustment for medical effectiveness research: an overview of conceptual and methodological considerations. J Investig Med. 1995; 43(2):136-50. View

10.

Steen P, Brewster A, Bradbury R, Estabrook E, Young J . Predicted probabilities of hospital death as a measure of admission severity of illness. Inquiry. 1993; 30(2):128-41. View

11.

EDWARDS F, Clark R, Schwartz M . Practical considerations in the management of large multiinstitutional databases. Ann Thorac Surg. 1994; 58(6):1841-4. DOI: 10.1016/0003-4975(94)91724-8. View

12.

Ferraris V, Ferraris S, Singh A . Operative outcome and hospital cost. J Thorac Cardiovasc Surg. 1998; 115(3):593-602; discussion 602-3. DOI: 10.1016/S0022-5223(98)70324-1. View

13.

Nashef S, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999; 16(1):9-13. DOI: 10.1016/s1010-7940(99)00134-7. View

14.

Clark R . The STS Cardiac Surgery National Database: an update. Ann Thorac Surg. 1995; 59(6):1376-80; discussion 1380-1. DOI: 10.1016/0003-4975(95)00288-v. View

15.

Takkenberg J, Kappetein A, Steyerberg E . The role of EuroSCORE II in 21st century cardiac surgery practice. Eur J Cardiothorac Surg. 2012; 43(1):32-3. DOI: 10.1093/ejcts/ezs271. View

16.

Tu J, Jaglal S, Naylor C . Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation. 1995; 91(3):677-84. DOI: 10.1161/01.cir.91.3.677. View

17.

Knaus W, Wagner D, Zimmerman J, Draper E . Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993; 118(10):753-61. DOI: 10.7326/0003-4819-118-10-199305150-00001. View