Key result
The modified CASUS, combining preoperative EuroSCORE and postoperative CASUS, did not significantly improve the accuracy of ICU mortality prediction compared to the additive CASUS alone.
Why the study?
Does the modified CASUS score improve the prediction of ICU mortality compared to the original additive CASUS score in adult patients after cardiac surgery?
Cohort (n=5,207)
No
Does the modified CASUS score improve the prediction of ICU mortality compared to the original additive CASUS score in adult patients after cardiac surgery?
Absolute Event Rate: 0.914% vs 0.905%
p-value: p=0.472
Combining preoperative and postoperative scoring systems into a modified CASUS score does not significantly improve the accuracy of ICU mortality prediction after cardiac surgery compared to the postoperative CASUS score alone.
Additive CASUS suffices for post-cardiac surgery ICU mortality prediction; leaves open whether alternative variables enhance accuracy in refined models.
BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (<0.05) in calibration. We detected the best OCC during the 2nd day (modified: 96.5%; original: 96.6%). CONCLUSIONS Our 'additive' and 'modified' CASUS are reasonable overall predictors. We could not detect any improvement in the accuracy of mortality prediction in cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.
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Doerr et al. (2015) conducted a cohort in Cardiac surgery (n=5,207). Modified CASUS (combination of additive EuroSCORE and additive CASUS) vs. Additive CASUS was evaluated on ICU mortality prediction accuracy (AUC on ICU-day 1) (p=0.472). The modified CASUS, combining preoperative EuroSCORE and postoperative CASUS, did not significantly improve the accuracy of ICU mortality prediction compared to the additive CASUS alone.
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