What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac surgery (n=2106). Intervention: EuroSCORE model (additive and logistic) vs. Observed outcomes. Primary outcome: Operative mortality (AUC 0.81).

What does this research mean for the field?

The additive and logistic EuroSCORE models overestimate operative mortality and have poor calibration in Australian cardiac surgery patients, indicating they may not accurately predict outcomes in this population. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 22, 2005Open Access

Validation of EuroSCORE model in an Australian patient population

Key Result

The additive and logistic EuroSCORE models overestimated operative mortality (predicted 5.75% and 9.93% vs observed 3.85%) and had poor calibration in Australian cardiac surgery patients.

Study Design

Type

Cohort (n=2,106)

Multicenter

Yes

Structured PICO

Does the EuroSCORE model accurately predict operative mortality in an Australian adult cardiac surgical population?

Population

2,106 consecutive adult patients undergoing cardiac surgery at two Australian hospitals (St Vincent's Hospital, Melbourne and Geelong Hospital) between June 2001 and April 2004, including a subset undergoing isolated coronary artery bypass graft (CABG) surgery.

Intervention

Additive and logistic EuroSCORE risk prediction models

Comparator

Observed operative mortality

Outcome

Operative mortality (assessed via model discrimination using area under the ROC curve and calibration using Hosmer-Lemeshow chi2)hard clinical

The EuroSCORE models significantly overestimate operative mortality in Australian cardiac surgery patients and may not be suitable for accurate risk prediction in this population without recalibration.

Main Result

Effect estimate: AUC 0.81

Abstract

BACKGROUND: The purpose of the present paper was to assess the performance of the European system for cardiac operative risk evaluation (EuroSCORE) model in an Australian adult cardiac surgical population. METHODS: The additive and logistic EuroSCORE models were retrospectively applied to predict operative mortality in 2106 consecutive patients undergoing cardiac surgery at St Vincent's Hospital, Melbourne between June 2001 and August 2003, and at Geelong Hospital between June 2001 and April 2004. The entire cohort and a subset of patients undergoing isolated coronary artery bypass graft (CABG) surgery were analysed. Model discrimination and calibration was tested by determining the area under the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow chi2, respectively. RESULTS: There were significant differences in the prevalence of risk factors between the Australian and European cardiac surgical populations. There were 81 deaths (observed mortality 3.85%) in the entire cohort and 39 deaths in the isolated CABG group (observed mortality 2.60%). The EuroSCORE models overestimated mortality (entire cohort: additive predicted 5.75%, logistic predicted 9.93%; isolated CABG: additive predicted 4.87%, logistic predicted 7.71%). Discriminative power was very good for the entire cohort (area under ROC curve, 0.81 (additive) and 0.82 (logistic)). Calibration of both models was poor. CONCLUSION: The additive and logistic EuroSCORE model of risk prediction was not validated in the present population of cardiac surgical patients. The models may not accurately predict outcomes of patients undergoing cardiac surgery in Australia.