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External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population
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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Cirurgia Cardiovascular
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873780/ https://www.ncbi.nlm.nih.gov/pubmed/29617500 http://dx.doi.org/10.21470/1678-9741-2017-0030 |
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author | Atashi, Alireza Amini, Shahram Tashnizi, Mohammad Abbasi Moeinipour, Ali Asghar Aazami, Mathias Hossain Tohidnezhad, Fariba Ghasemi, Erfan Eslami, Saeid |
author_facet | Atashi, Alireza Amini, Shahram Tashnizi, Mohammad Abbasi Moeinipour, Ali Asghar Aazami, Mathias Hossain Tohidnezhad, Fariba Ghasemi, Erfan Eslami, Saeid |
author_sort | Atashi, Alireza |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5873780 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
record_format | MEDLINE/PubMed |
spelling | pubmed-58737802018-04-02 External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population Atashi, Alireza Amini, Shahram Tashnizi, Mohammad Abbasi Moeinipour, Ali Asghar Aazami, Mathias Hossain Tohidnezhad, Fariba Ghasemi, Erfan Eslami, Saeid Braz J Cardiovasc Surg Original Article 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. Sociedade Brasileira de Cirurgia Cardiovascular 2018 /pmc/articles/PMC5873780/ /pubmed/29617500 http://dx.doi.org/10.21470/1678-9741-2017-0030 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Atashi, Alireza Amini, Shahram Tashnizi, Mohammad Abbasi Moeinipour, Ali Asghar Aazami, Mathias Hossain Tohidnezhad, Fariba Ghasemi, Erfan Eslami, Saeid External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population |
title | External Validation of European System for Cardiac Operative Risk
Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian
Population |
title_full | External Validation of European System for Cardiac Operative Risk
Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian
Population |
title_fullStr | External Validation of European System for Cardiac Operative Risk
Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian
Population |
title_full_unstemmed | External Validation of European System for Cardiac Operative Risk
Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian
Population |
title_short | External Validation of European System for Cardiac Operative Risk
Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian
Population |
title_sort | external validation of european system for cardiac operative risk
evaluation ii (euroscore ii) for risk prioritization in an iranian
population |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873780/ https://www.ncbi.nlm.nih.gov/pubmed/29617500 http://dx.doi.org/10.21470/1678-9741-2017-0030 |
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