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External Validation of European System for Cardiac Operative Risk Evaluation Ii (Euroscore Ii) for Risk Prioritization in an Iranian Population Publisher Pubmed



Atashi A1, 2 ; Amini S3 ; Tashnizi MA4 ; Moeinipour AA4 ; Aazami MH5 ; Tohidnezhad F1 ; Ghasemi E6 ; Eslami S1, 7, 8
Authors
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Authors Affiliations
  1. 1. Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  2. 2. Medical Informatics Department, Breast Cancer Research Center, Moatamed Cancer Institute, ACECR, Tehran, Iran
  3. 3. Department of Anesthesiology and Critical Care, Mashhad University of Medical Sciences, Mashhad, Iran
  4. 4. Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
  5. 5. Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  6. 6. Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  7. 7. Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  8. 8. Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

Source: Brazilian Journal of Cardiovascular Surgery Published:2018


Abstract

Introduction: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran. © 2018, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.
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1. The Prospective Validation of Euroscore Ii Risk Scoring System for Patients Underwent Cardiac Surgery: Brief Report, Tehran University Medical Journal (2018)
2. Assessment of the Euroscore Risk Scoring System for Patients Undergoing Coronary Artery Bypass Graft Surgery in a Group of Iranian Patients, Indian Journal of Critical Care Medicine (2015)
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