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Development of the Post Cardiac Surgery (POCAS) prognostic score

INTRODUCTION: The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in de...

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Autores principales: Tamayo, Eduardo, Fierro, Inma, Bustamante-Munguira, Juan, Heredia-Rodríguez, María, Jorge-Monjas, Pablo, Maroto, Laura, Gómez-Sánchez, Esther, Bermejo-Martín, Francisco Jesús, Álvarez, Francisco Javier, Gómez-Herreras, José Ignacio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057191/
https://www.ncbi.nlm.nih.gov/pubmed/24063719
http://dx.doi.org/10.1186/cc13017
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author Tamayo, Eduardo
Fierro, Inma
Bustamante-Munguira, Juan
Heredia-Rodríguez, María
Jorge-Monjas, Pablo
Maroto, Laura
Gómez-Sánchez, Esther
Bermejo-Martín, Francisco Jesús
Álvarez, Francisco Javier
Gómez-Herreras, José Ignacio
author_facet Tamayo, Eduardo
Fierro, Inma
Bustamante-Munguira, Juan
Heredia-Rodríguez, María
Jorge-Monjas, Pablo
Maroto, Laura
Gómez-Sánchez, Esther
Bermejo-Martín, Francisco Jesús
Álvarez, Francisco Javier
Gómez-Herreras, José Ignacio
author_sort Tamayo, Eduardo
collection PubMed
description INTRODUCTION: The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score. METHODS: We conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series. RESULTS: In-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score). CONCLUSIONS: Our new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation.
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spelling pubmed-40571912014-06-14 Development of the Post Cardiac Surgery (POCAS) prognostic score Tamayo, Eduardo Fierro, Inma Bustamante-Munguira, Juan Heredia-Rodríguez, María Jorge-Monjas, Pablo Maroto, Laura Gómez-Sánchez, Esther Bermejo-Martín, Francisco Jesús Álvarez, Francisco Javier Gómez-Herreras, José Ignacio Crit Care Research INTRODUCTION: The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score. METHODS: We conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series. RESULTS: In-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score). CONCLUSIONS: Our new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation. BioMed Central 2013 2013-09-24 /pmc/articles/PMC4057191/ /pubmed/24063719 http://dx.doi.org/10.1186/cc13017 Text en Copyright © 2013 BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Tamayo, Eduardo
Fierro, Inma
Bustamante-Munguira, Juan
Heredia-Rodríguez, María
Jorge-Monjas, Pablo
Maroto, Laura
Gómez-Sánchez, Esther
Bermejo-Martín, Francisco Jesús
Álvarez, Francisco Javier
Gómez-Herreras, José Ignacio
Development of the Post Cardiac Surgery (POCAS) prognostic score
title Development of the Post Cardiac Surgery (POCAS) prognostic score
title_full Development of the Post Cardiac Surgery (POCAS) prognostic score
title_fullStr Development of the Post Cardiac Surgery (POCAS) prognostic score
title_full_unstemmed Development of the Post Cardiac Surgery (POCAS) prognostic score
title_short Development of the Post Cardiac Surgery (POCAS) prognostic score
title_sort development of the post cardiac surgery (pocas) prognostic score
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057191/
https://www.ncbi.nlm.nih.gov/pubmed/24063719
http://dx.doi.org/10.1186/cc13017
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