EuroSCORE II showed good overall discrimination for predicting in-hospital mortality in UK cardiac surgery (AUC 0.808; 95% CI 0.793-0.824), but failed calibration (P=0.003) due to over-prediction.
Cross-Sectional (n=23,740)
Yes
Does the EuroSCORE II risk model accurately predict in-hospital mortality in contemporary UK cardiac surgery patients?
EuroSCORE II provides acceptable overall discrimination for contemporary UK cardiac surgery but suffers from calibration issues, particularly in isolated CABG and at risk extremes.
Effect estimate: AUC 0.808 (95% CI 0.793 to 0.824)
Absolute Event Rate: 3.4% vs 3.1%
p-value: p=0.003
Objective The original EuroSCORE models are poorly calibrated for predicting mortality in contemporary cardiac surgery. EuroSCORE II has been proposed as a new risk model. The objective of this study was to assess the performance of EuroSCORE II in UK cardiac surgery. Design A cross-sectional analysis of prospectively collected multi-centre clinical audit data, from the Society for Cardiothoracic Surgery in Great Britain and Ireland Database. Setting All NHS hospitals, and some UK private hospitals performing adult cardiac surgery. Patients 23 740 procedures at 41 hospitals between July 2010 and March 2011. Main outcome measures The main outcome measure was in-hospital mortality. Model calibration (Hosmer–Lemeshow test, calibration plot) and discrimination (area under receiver operating characteristic curve) were assessed in the overall cohort and clinically defined sub-groups. Results The mean age at procedure was 67.1 years (SD 11.8) and 27.7% were women. The overall mortality was 3.1% with a EuroSCORE II predicted mortality of 3.4%. Calibration was good overall but the model failed the Hosmer–Lemeshow test (p=0.003) mainly due to over-prediction in the highest and lowest-risk patients. Calibration was poor for isolated coronary artery bypass graft surgery (Hosmer–Lemeshow, p<0.001). The model had good discrimination overall (area under receiver operating characteristic curve 0.808, 95% CI 0.793 to 0.824) and in all clinical sub-groups analysed. Conclusions EuroSCORE II performs well overall in the UK and is an acceptable contemporary generic cardiac surgery risk model. However, the model is poorly calibrated for isolated coronary artery bypass graft surgery and in both the highest and lowest risk patients. Regular revalidation of EuroSCORE II will be needed to identify calibration drift or clinical inconsistencies, which commonly emerge in clinical prediction models.
Grant et al. (Tue,) conducted a cross-sectional in adult cardiac surgery (n=23,740). EuroSCORE II vs. Observed mortality was evaluated on in-hospital mortality (AUC 0.808, 95% CI 0.793 to 0.824, p=0.003). EuroSCORE II showed good overall discrimination for predicting in-hospital mortality in UK cardiac surgery (AUC 0.808; 95% CI 0.793-0.824), but failed calibration (P=0.003) due to over-prediction.
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