Predicitve Discrimination Power of EuroSCORE II and The Addition of TAPSE to EuroSCORE II Improving the Predictive Discrimination Power on Inhospital Mortality After Cardiac Surgery in Indonesian Subpopulation, North Sumatra

Author : B.G. Napitupulu, R.A.Ginting, Z.Syahputra, D. Prabisma, A.N.Nasution, H. Hassan
Upload Date : 19-04-2018

Background: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II has been released to improve mortality prediction in cardiac surgery but has not validated yet either over generally Asian population or Indonesian subpopulation. EuroSCORE predictive ability on other race population were tend to be mismatch for some parameters are lack on quantitative findings. The significant objective pre operative data can improve the discriminative prediction for mortality of EuroSCORE especially for Asian and Indonesian subpopulation.

Methods: Data were recorded over 190 patients undergoing cardiac surgery in Cardiac Centre Haji Adam Malik General Hospital Medan, North Sumatra, Indonesia. EuroSCORE were applied from pre operative data and the predictive and observed inhospital mortality were analyzed. Each clinical and echocardiographic parameters were also analyzed by bivariate correlation and together were compared by regression logistic analysis and receiver operator characteristic cuves (ROC) to find the best AUC model.

Results: Overall inhospital mortality rate were 9.47%, with 6% were in CABG and 3.47% in non coronary surgery while around 64.7% CABG patient were on low risk EuroSCORE. EuroSCORE has a weak positive correlation ( r 0.145; p 0.046 ) and TAPSE (Tricuspid Anular Plane Systolic Excursion) has a moderate negative correlation with inhospital mortality (r 0.318; p <0.01 ). There were a significant TAPSE difference (p 0.06) and EuroSCORE (p 0.017) on inhospital mortality incidence. EuroSCORE can be accepted as a model with AUC 0.643 (OR 1.536;  CI 1.049-2.248, p 0.027) but mortality in our population was higher than expected by the EuroSCORE (O/E= 18). TAPSE < 17.5 had a influence on inhospital mortality (OR 7.749; CI 2.771-21.667) with AUC 0.721 (p 0.02). A better discrimination power (AUC 0.767; p <0.01) were seen on combination of TAPSE and EuroSCORE.

Conclusion: EuroSCORE underestimated inhospital mortality in our population. TAPSE as a simple preoperative data can be considered to predict inhospital mortality, and the addition of TAPSE to EuroSCORE can improve the discrimination power for predicting inhospital mortality

KEYWORDS : EuroSCORE II, Asian, Indonesia, TAPSE, mortality

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