Prediction of Early and Late mortality outcome in patients undergoing Valvular Heart surgeries using EuroSCORE II

Abstract

BACKGROUND: The European System for Cardiac Operation Risk Evaluation (EuroSCORE) is one of the
possible tools to assess the peri-operative mortality risk in patients undergoing cardiac valvular surgeries. In order to
improve the poor calibration and to optimize EuroSCORE usefulness, an updated version of this model named as
EuroSCORE II, was better calibrated than the original model in detecting hospital mortality preserving high
discrimination.
OBJECTIVES:(1).Preoperative EuroSCORE Calculation in cardiac surgical patients undergoing valvular heart
surgeries ( 2).Analysing one week, one month, 6 months, 1 year, mortality in these patients (3). A Corelation of
preoperative risk evaluation by EuroSCORE II with postoperative mortality.
STUDY DESIGN: A prospective observational study.
PARTICIPANTS:A total of 56 patients of any gender, age of more than 18 years, admitted for elective or urgent
cardiac valve surgeries over a period of two years were included in the study.
METHODS: Baseline and peri-operative data was collected prospectively which included the variables needed to
estimate the operative risk based on EuroSCORE II. The risk score was determined with an online interactive
calculator(http://www.euroscore.org/calc.html).Patients were followed prospectively in the post-operative period at
one week, one month, at six months and at the end of one year. The primary end point was in hospital mortality and
mortality upto one year. Early mortality was taken as mortality at the end of one week and one month and late
mortality was taken at the end of six months and one year. During follow up, data was obtained through outpatient
clinical review.
RESULTS:
There was no significant difference between expected and observed mortality in accordance to the EuroSCORE II
model (p = 0.076) suggesting good calibration of the model in this population for early mortality. The area under the
receiver operating characteristic (ROC) curve for EuroSCORE II was 0.85 (95% CI 0.712- 0.921) indicating a good
discriminatory power for early mortality.The area under the ROC curve of EuroSCORE II for predicting late
mortality was 0.493 (95% CI 0.367-0.641) indicating a poor discriminatory power.
CONCLUSIONS:
EuroSCORE II has a good discriminatory power and calibration for prediction of early mortality (in hospital
mortality and mortality upto 1 month). The EuroSCORE II estimated risk should not be considered a direct measure
of long term mortality as its predictive power(performance) decrease significantly for mortality at a follow up longer
than 30 days.