Key result
Parsonnet score shows moderate discrimination for in-hospital cardiac surgery mortality with ~0.70 AUC.
Why the study?
Risk stratification models like the Parsonnet score need validation in different populations to assess their predictive accuracy for mortality after adult cardiac surgery in India.
Observational (n=889)
No
Answers are grounded in this paper and cite their sources.
Parsonnet score offers only moderate mortality prediction; leaves open need for updated models in contemporary cardiac surgery.
AIMS AND OBJECTIVES: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. MATERIALS AND METHODS: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in-hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub-groups coronary artery bypass grafting (CABG), valve surgery and combined procedures (CABG with valve surgery). The model calibration was performed using Hosmer-Lemeshow goodness of fit test and receiver operating characteristics (ROC) analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. RESULTS: The overall mortality was 6.3% (56 patients), 7.1% (34 patients) for CABG, 4.3% (16 patients) for valve surgery and 16.2% (6 patients) for combined procedures. The Hosmer-Lemeshow statistic was <0.05 for the total data and also within the sub-groups suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62-0.77) and when tested separately, it was 0.73 (0.64-0.81) for CABG, 0.79 (0.63-0.92) for valve surgery (good discriminatory ability) and only 0.55 (0.26-0.83) for combined procedures. The independent predictors of mortality determined for the total data were low ejection fraction (odds ratio [OR] - 1.7), preoperative intra-aortic balloon pump (OR - 10.7), combined procedures (OR - 5.1), dialysis dependency (OR - 23.4), and re-operation (OR - 9.4). CONCLUSIONS: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive value for the total data and for CABG and poor predictive value for combined procedures.
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Moningi et al. (2015) conducted an observational in Adult cardiac surgery (n=889). Parsonnet risk scoring model was evaluated on Discriminatory ability of Parsonnet score for predicting in-hospital mortality (Area under the ROC curve) (AUC 0.699, 95% CI 0.62-0.77). The Parsonnet score demonstrated moderate discriminative ability for predicting in-hospital mortality following adult cardiac surgery, with an overall area under the ROC curve of 0.699.
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