Key result
The Post Cardiac Surgery (POCAS) score, utilizing four parameters upon ICU admission, predicted 90-day in-hospital mortality with an AUC of 0.890, outperforming other established risk scores.
Why the study?
Does the POCAS score predict 90-day in-hospital mortality better than existing risk scores in adult patients undergoing cardiac surgery with cardiopulmonary bypass?
Cohort (n=920)
No
Does the POCAS score predict 90-day in-hospital mortality better than existing risk scores in adult patients undergoing cardiac surgery with cardiopulmonary bypass?
Effect estimate: AUC 0.890 (95% CI 0.86-0.93)
Absolute Event Rate: 0.89% vs 0.847%
p-value: p=<0.001
The POCAS score, based on four routine parameters upon ICU admission, provides a highly accurate and simple tool for predicting 90-day mortality after cardiac surgery, outperforming standard preoperative risk models.
May support early mortality risk stratification after cardiac surgery; leaves open need for prospective validation before clinical adoption.
INTRODUCTION: The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score. METHODS: We conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series. RESULTS: In-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score). CONCLUSIONS: Our new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation.
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Tamayo et al. (2013) conducted a cohort in Cardiac surgery with cardiopulmonary bypass (n=920). Post Cardiac Surgery (POCAS) prognostic score vs. Other risk scores (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, ACEF) was evaluated on Accuracy in predicting 90-day in-hospital mortality (Area Under the ROC Curve) (AUC 0.890, 95% CI 0.86-0.93, p=<0.001). The Post Cardiac Surgery (POCAS) score, utilizing four parameters upon ICU admission, predicted 90-day in-hospital mortality with an AUC of 0.890, outperforming other established risk scores.
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