Validation of the EuroSCORE Probabilistic Model in Patients Undergoing Coronary Bypass Grafting

• Published in: Revista española de cardiologia Vol. 61; no. 6; pp. 589 - 594
• Main Authors: Lafuente, Sarah, Trilla, Antoni, Bruni, Laia, González, Raquel, Bertrán, María J., Pomar, José Luis, Asenjo, Miguel A.
• Format: Journal Article
• Language: English; Spanish
• Published: Spain Elsevier Espana 01.06.2008
• Subjects: Aged; Coronary Artery Bypass; Coronary artery bypass grafting; Evaluación de resultados; Female; Humans; In-hospital mortality; Injerto coronario; Male; Middle Aged; Modelo probabilístico; Models, Statistical; Mortalidad hospitalaria; Probabilistic model; Quality evaluation; Risk Assessment - methods; Spain; Spain; In-hospital mortality; Injerto coronario; EU-A; HCB; ROC; Quality evaluation; Mortalidad hospitalaria; EU-L; Modelo probabilístico; Evaluación de resultados; Coronary artery bypass grafting; EuroSCORE; Probabilistic model
• ISSN: 1885-5857; 1885-5857; 1579-2242
• DOI: 10.1016/S1885-5857(08)60182-6

EuroSCORE utilizes a probabilistic model for predicting the risk of in-hospital mortality in patients undergoing cardiac surgery. It is a useful instrument for evaluating quality of care. The model has two variants: the logistic EuroSCORE and the additive EuroSCORE. The aim of this study was to validate the EuroSCORE model in patients undergoing surgery at Hospital Clínic in Barcelona, Spain, and to compare the results obtained with the 2 variants. The study included all patients who received a coronary artery bypass graft (CABG) at Hospital Clínic in Barcelona in 2 consecutive years. The model's validity was assessed on the basis of its calibration (using the Hosmer-Lemeshow test) and its discrimination (using the receiver operating characteristic [ROC] curve). The 2 models were compared by carrying out a descriptive analysis of mortality for the whole group and for different risk groups, and by determining the models' discriminative power. A total of 498 patients underwent CABG surgery and were included in the study. The Hosmer-Lemeshow test showed that the model's calibration was satisfactory ( P=.32) and the area under the ROC curve was 0.83. The observed in-hospital mortality rate was 5.8%. The predicted rate was 4.2% with the logistic EuroSCORE and 3.9% with the additive EuroSCORE. Large differences were observed in high-risk patients. In these patients, the mortality predicted by the logistic variant was closer to the actual mortality. EuroSCORE's validity was found to be satisfactory and the model can be used to evaluate quality of care. In high-risk patients, mortality estimated using the logistic model was closer to the actual mortality. EuroSCORE es un modelo probabilístico para estimar la probabilidad de mortalidad hospitalaria en pacientes sometidos a cirugía cardiaca. Es un instrumento útil para evaluar la calidad asistencial. Existen dos variantes del modelo, el EuroSCORE logístico (EU-L) y el EuroSCORE aditivo (EU-A). El objetivo del estudio es validar el modelo EuroSCORE en pacientes intervenidos en el Hospital Clínic de Barcelona y comparar los resultados de las dos variantes del modelo. Se ha incluido a los pacientes intervenidos de injerto coronario en el Hospital Clínic de Barcelona durante 2 años consecutivos. Se ha validado el modelo a partir de su capacidad de calibración (prueba de Hosmer-Lemeshow) y discriminación (área bajo la curva ROC). Se han comparado los dos modelos con un análisis descriptivo de la media de la mortalidad para el total y según grupos de riesgo y mediante su poder de discriminación. Un total de 498 pacientes fueron intervenidos e incluidos en el estudio. La calibración del modelo es satisfactoria (p = 0,32) y el área bajo la curva ROC es de 0,83. La mortalidad hospitalaria observada alcanzó el 5,8% y la estimada, el 4,2% (EU-L) y el 3,9% (EU-A). Se han observado mayores diferencias en el grupo de pacientes de alto riesgo, en los que la mortalidad predicha por la variante logística se aproxima más a la mortalidad real. EuroSCORE ha sido validado adecuadamente y puede utilizarse para medir los resultados de la práctica asistencial. El modelo logístico se aproxima más a la mortalidad real en el grupo de pacientes de alto riesgo.