Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery?

OBJECTIVE Risk stratification allows preoperative assessment of cardiac surgical risk faced by individual patients and permits retrospective analysis of postoperative complications in the intensive care unit (ICU). The aim of this single-center study was to investigate the prediction of extended ICU stay after cardiac surgery using both the additive and logistic model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS A retrospective observational study was conducted. We collected clinical data of 1562 consecutive patients undergoing cardiac surgery over a 2-year period at the Antwerp University Hospital, Belgium. EuroSCORE values of all patients were obtained. The outcome measure was the duration of ICU stay in days. The predictive performance of EuroSCORE was analyzed by the discriminatory power of a receiver operating characteristic (ROC) curve. Each EuroSCORE value was used as a theoretical cut-off point to predict duration of ICU stay. Three subsequent ICU stays were defined as prolonged: more than 2, 5 and 7 days. ROC curves were constructed for both the additive and logistic model. RESULTS Patients had a median ICU stay of 2 days and a mean ICU stay of 5.5 days. Median additive EuroSCORE was 5 (range, 0-22) and logistic EuroSCORE was 3.94% (range, 0.00-87.00). In the additive EuroSCORE model, a predictive value of 0.76 for an ICU stay of >7 days, 0.72 for >5 days and 0.67 for >2 days was found. The logistic EuroSCORE model yielded an area under the ROC curve of 0.77, 0.75 and 0.68 for each ICU length of stay, respectively. CONCLUSIONS In our patient database, prolonged length of stay in the ICU correlated positively with EuroSCORE. The logistic model was more discriminatory than the additive in tracing extended ICU stay. The overall predictive performance of EuroSCORE is acceptable and most likely based on the presence of variables that are risk factors for both mortality and extended ICU stay. Hence, EuroSCORE is a useful predicting tool and provides both surgeons and intensivists with a good estimate of patient risk in terms of ICU stay.

[1]  Timothy J Gardner,et al.  ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). , 2004, Circulation.

[2]  M. Zweig,et al.  Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. , 1993, Clinical chemistry.

[3]  R. Elton,et al.  The Edinburgh Cardiac Surgery Score survival prediction in the long-stay ICU cardiac surgical patient. , 1995, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  Salvatore Colangelo,et al.  Can EuroSCORE predict direct costs of cardiac surgery? , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[5]  B Bridgewater,et al.  Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms , 1998, Heart.

[6]  M. Mora,et al.  Mortality prediction in cardiac surgery patients: comparative performance of Parsonnet and general severity systems. , 1999, Circulation.

[7]  A. Bernard,et al.  Is the Parsonnet's score a good predictive score of mortality in adult cardiac surgery: assessment by a French multicentre study. , 1997, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  J A Swets,et al.  Measuring the accuracy of diagnostic systems. , 1988, Science.

[9]  J. Tu,et al.  Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. , 1995, Circulation.

[10]  Carsten Lührs,et al.  EuroSCORE predicts intensive care unit stay and costs of open heart surgery. , 2004, The Annals of thoracic surgery.

[11]  S. Lemeshow,et al.  European system for cardiac operative risk evaluation (EuroSCORE). , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[12]  J. Hanley,et al.  A method of comparing the areas under receiver operating characteristic curves derived from the same cases. , 1983, Radiology.

[13]  G. Beck,et al.  ICU admission score for predicting morbidity and mortality risk after coronary artery bypass grafting. , 1997, The Annals of thoracic surgery.

[14]  N. Doll,et al.  Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting , 2004, Intensive Care Medicine.

[15]  A. Grayson,et al.  Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting , 2006, Journal of cardiothoracic surgery.

[16]  V. Ivančan,et al.  Health related quality of life following cardiac surgery--correlation with EuroSCORE. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  A. Bernstein,et al.  A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. , 1989, Circulation.

[18]  J. Ornato,et al.  ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). , 2004, Circulation.

[19]  R. Salamon,et al.  Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[20]  N. Starr,et al.  Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery* , 1998, Critical care medicine.