Key result
In a registry with 7.69% overall in-hospital mortality, ArgenSCORE II accurately predicted risk in centers with <6% mortality, while ArgenSCORE I performed better in centers with >6% mortality.
Why the study?
To evaluate whether ArgenSCORE II better predicts in-hospital mortality in low-mortality centers while ArgenSCORE I better predicts mortality in high-mortality centers.
Does the ArgenSCORE II better predict in-hospital mortality in low-mortality centers compared to the ArgenSCORE I?
Observational (n=2,548)
Yes
Does the ArgenSCORE II better predict in-hospital mortality in low-mortality centers compared to the ArgenSCORE I?
The recalibrated ArgenSCORE II is recommended for cardiac surgery centers with mortality <6%, while the original ArgenSCORE I performs better in centers with mortality >6%.
Answers are grounded in this paper and cite their sources.
ArgenSCORE calibration varies by center mortality; hypothesis-generating for context-specific use pending prospective validation.
Background: The ArgenSCORE I was developed in 1999 on a population with 8% mortality. The ArgenSCORE II emerged after recalibrating the original model in 2007 on a validation population with 4% mortality. Using the CONAREC XVI registry, we evaluated the hypothesis that the ArgenSCORE II could better predict the risk of in-hospital mortality in centers with low mortality, whereas the ArgenSCORE I could better predict mortality in centers with high mortality. Methods: A total of 2548 patients from 44 centers of the prospective and multicenter cardiac surgery CONAREC XVI registry, were analyzed. Mean observed mortality (OM) and mean expected mortality (EM) were estimated applying both versions of the ArgenSCORE. The OM/EM ratio was calculated in each center for both models and the Z test was used to evaluate significant differences. Results: In-hospital mortality was 7.69% for the entire registry. In 75% of the centers (33/44) mortality was >6%. In centers with mortality <6%, the OM/EM ratio was close to 1 after applying the ArgenSCORE II, without significant differences. In centers with mortality > 6%, the ArgenSCORE II significantly underestimated the risk. On the contrary, when the ArgenSCORE I was applied in these centers, the OM/EM ratio was close to 1, without significant differences. Conclusions: The recalibrated ArgenSCORE II is recommended in centers with mortality < 6%, while in those with mortality > 6% the original ArgenSCORE I has better performance.
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Carosella et al. (2021) conducted an observational in Cardiovascular Surgery (n=2,548). ArgenSCORE II vs. ArgenSCORE I was evaluated on In-hospital mortality prediction (OM/EM ratio). In a registry with 7.69% overall in-hospital mortality, ArgenSCORE II accurately predicted risk in centers with <6% mortality, while ArgenSCORE I performed better in centers with >6% mortality.
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