Predictive value of euroscopre in Pakistani cardiac surgical patients

ABSTRACT

To evaluate the predictive value of European System for Cardiac Operative Risk Evaluation [EuroSCORE] of early mortality in Pakistani cardiac surgical population in a single cardiac center. A prospective, single institution, observational cohort study. Department of Cardiac Surgery AFIC Rawalpindi from 1st January, 2009 to 31st December 2009. A total of 1064 consecutive adult patients undergoing cardiac surgical intervention at department of adult cardiac surgery from 1st January 2009 to 31st December 2009 were included in the study. The logistic EuroSCORE score was estimated for all the patients and compared with the observed 30 day mortality. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model and the area under the receiver operating characteristic [ROC] curve was measured to analyse the EuroSCORE discriminative power on individual death prediction. Expected mortality was compared to observed or actual mortality. Mortality was defined as death from any cause within 30 days of operation or within the same hospital admission. The Hosmer-Lemeshow test revealed a good calibration power [p = 0.73] and the area under the ROC curve was 0.753, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients [18.18%] was very high as compared to predicted mortality [8.14%]. EuroSCORE is a reasonably good relevant predictor of immediate post-operative mortality in low and intermediate risk groups after cardiac surgery in Pakistani population, but is less predictive for high-risk patients