Validation of EuroSCORE II in predicating in-hospital mortality among Chinese patients undergoing heart valve surgery / 第二军医大学学报

ABSTRACT

Objective To assess the performance of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE I) in predicating in-hospital mortality among Chinese patients undergoing heart valve surgery at our center. Methods From January 2006 to December 2011, 3 479 consecutive patients who underwent heart valve surgery at our center were enrolled in this study and they were scored by the original EuroSCORE(addtive EuroSCORE and logistic EuroSCORE) and EuroSCORE II model. The actual mortality rate of patients was compared with those of the predicted ones. The performances of the original EuroSCORE and EuroSCORE II model were assessed by the Hosmer-Lemeshow (H-L) test. The discrimination validity of prediction was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results There were 112 in-hospital deaths among the 3 479 patients, with an in-hospitalmortality rate of 3. 2%, compared to the predicted mortality rates of 3. 84% by the additive EuroSCORE (H-L P = 0. 013, suggesting a higher prediction),3. 33% by the logistic EuroSCORE (H-L P= 0. 08, suggesting good consistency), and 2.52% by the EuroSCORE II (H-L P<0. 0001, suggesting a lower prediction). EuroSCORE II showed a good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H-L P = 0. 103, area under the ROC curve of 0. 792) and a poor calibration for patients undergoing multiple valve surgery (H-L P<0. 0001, area under the ROC curve of 0. 605). The discriminative powers of the predictions by additive EuroSCORE, logistic EuroSCORE, andEuroSCORE I were poor for the entire cohort, with the areas under the ROC curve being 0.684, 0. 673, and 0. 685, respectively. Conclusion EuroSCORE II has abetter accuracy for predicting mortality of patients undergoing single valve surgery, but not for those undergoing multiple valve surgery, which should be considered in clinical practice.