Key result
Adding immediate postoperative variables improves prediction of post-cardiac surgery organ dysfunction or death to AUC ~0.77.
Why the study?
Current risk stratification tools fail to adequately incorporate both preoperative vulnerability and immediate postoperative physiological derangements to predict early organ dysfunction or death after cardiac surgery.
Cohort (n=1,394)
Yes
Integrating immediate postoperative physiological variables like SOFA score and CPB duration with preoperative risk factors significantly improves the early prediction of organ dysfunction or death after cardiac surgery.
Answers are grounded in this paper and cite their sources.
May improve early postoperative risk stratification; extends preoperative models but leaves open external validation before clinical use.
BACKGROUND: Development of organ dysfunction or death is still common in patients undergoing cardiac surgery. Yet, current risk stratification tools fail to adequately incorporate both preoperative vulnerability and immediate postoperative physiological derangements. This study aims to develop a predictive model integrating these critical timepoints to identify high-risk patients for presence of organ dysfunction or death 48 hours after surgery. METHODS: This is a post hoc analysis of an international, multicenter, randomized, controlled trial in patients undergoing cardiac surgery (n=1394). Prespecified patient characteristics (age, Clinical Frailty Scale, at nutrition risk, combined procedures, urgent surgery, moderate-severe chronic kidney disease, left ventricular ejection fraction, European System for Cardiac Operative Risk Evaluation II, cardiopulmonary bypass duration, sex, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score) were included in logistic regression models employing bootstrap validation. RESULTS: A total of 434 (31.1%) patients had organ dysfunction or died 48 hours after surgery. The preoperative model identified Clinical Frailty Scale, nutrition risk, urgent surgery and European System for Cardiac Operative Risk Evaluation II as significant predictors of organ dysfunction or death 48 hours after surgery (optimism-corrected area under the receiver operating characteristic curve, 0.644 [95% CI, 0.610-0.678]). Incorporation of postoperative variables (Sequential Organ Failure Assessment score at intensive care unit admission, and cardiopulmonary bypass duration) improved predictive performance (area under the receiver operating characteristic curve, 0.773 [95% CI, 0.745-0.801]). CONCLUSIONS: Incorporation of variables collected the day of surgery substantially improved the ability to predict organ dysfunction or death 48 hours after surgery compared with using presurgical variables only. This pragmatic, clinically actionable model may enable targeted resource allocation and personalized interventions and may provide a stratification tool for future research. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT02002247.
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Dresen et al. (2026) conducted a cohort in Patients undergoing cardiac surgery (n=1,394). Preoperative and immediate postoperative variables (Clinical Frailty Scale, nutrition risk, urgent surgery, EuroSCORE II, SOFA score at ICU admission, CPB duration) vs. Preoperative variables only was evaluated on Presence of organ dysfunction or death 48 hours after surgery (AUC 0.773, 95% CI 0.745-0.801). Incorporation of immediate postoperative variables (SOFA score and CPB duration) with preoperative variables improved the prediction of organ dysfunction or death 48 hours after cardiac surgery (AUC 0.773) compared to preoperative variables alone (AUC 0.644).
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