In-hospital mortality risk assessment in elective and non-elective cardiac surgery: A comparison between EuroSCORE II and age, creatinine, ejection fraction score

Fabio Barili, Davide Pacini, Francesco Rosato, Maurizio Roberto, Alberto Battisti, Claudio Grossi, Francesco Alamanni, Roberto Di Bartolomeo, Alessandro Parolari

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: Age, creatinine, ejection fraction (ACEF) score is a simplified algorithm for prediction of mortality after elective cardiac surgery. Although mainly conceived for elective cardiac surgery, no information is available on its performance in non-elective surgery and on comparison with the new EuroSCORE II. This study was undertaken to compare the performance of ACEF score and EuroSCORE II within classes of urgency. METHODS: Complete data on 13 871 consecutive patients who underwent major cardiac surgery in a 6-year period were retrieved from three prospective institutional databases. Discriminatory power was assessed using the c-index and h with Delong, bootstrap and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. RESULTS: The in-hospital mortality rate was 2.5%. The discriminatory power of ACEF score within elective and non-elective surgery was similar (area under the curve (AUC) 0.71, 95% confidence interval (CI) 0.67-0.74 and AUC 0.68, 95% CI 0.62-0.73, respectively) but significantly lower than that of EuroSCORE II (AUC 0.80, 95% CI 0.77-0.83 for elective surgery; AUC 0.82, 95% CI 0.78-0.85 for non-elective surgery). The calibration patterns were different in the two subgroups, but the summary statistics underscored a miscalibration in both of them (U-statistic and Spiegelhalter Z-test P-values

Original languageEnglish
Article numberezt581
Pages (from-to)44-48
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume46
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • Epidemiology
  • Outcomes research
  • Risk factors
  • Risk score
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

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