Validation for EuroSCORE II in the Indonesian cardiac surgical population: a retrospective, multicenter study

Figures & data

Table 1. Demographic and comorbidity analysis.

	Total	Died	Alive	P
Age, mean ±SD	44.18 ± 14.10	50.79 ± 15.12	43.49 ± 13.82	<0.001
Female gender,n (%)
Male	379 (49.5)	46 (63.0)	333 (48.1)	0.048
Female	386 (50.5)	27 (37.0)	359 (51.9)
Chronic pulmonary disease, n (%)	9 (1.2)	6 (0.9)	3 (4.1)	0.014
Limited mobility, n(%)	6 (0.8)	3 (4.1)	3 (0.4)	0.001
Renal impairment				0.084
Normal	232 (30.2)	16 (21.9)	216 (31.1)
Moderate	375 (48.9)	36 (49.3)	339 (48.8)
Severe	133(0.3)	18 (24.7)	115 (16.6)
Dialysis	2 (0.3)	1 (1.4)	1 (0.1)
DM (insulin dependent), n (%)	16 (17.3)	3 (4.1)	13 (1.9)	0.203
Prior cardiac surgery, n (%)	8 (1.1)	2 (2.7)	6 (0.9)	0.239
Active endocarditis, n (%)	32 (4.3)	28 (4.1)	4 (5.6)	0.829
Critical preoperative condition,n (%)	1 (0.1)	1 (1.4)	0 (0)	0.002
Angina CCS 4, n (%)	1 (0.1%)	0 (0)	1 (0.1)	0.746
Functional class
NYHA I, n (%)	192 (25.8)	12 (16.7)	180 (26.8)	0.022
NYHA II, n (%)	447 (60.1)	43 (59.7)	404 (60.1)
NYHA III, n (%)	99 (13.3)	17 (23.6)	82 (12.2)
NYHA IV, n (%)	6 (0.8)	0 (0)	6 (0.9)
Left ventricular dysfunction
EF > 50%, n (%)	607 (82.4)	56 (76.7)	551 (83.0)	0.082
EF 31–50%, n (%)	106 (14.4)	12 (16.4)	94 (14.2)
EF 21–30%, n (%)	22 (3)	5 (6.8)	17 (2.6)
EF < 21%, n (%)	2 (0.3)	0 (0)	2 (0.3)
Recent myocardial infarction, n (%)	12 (1.6)	2 (2.7)	10 (1.4)	0.662
Pulmonary hypertension				0.044
No	608 (79.3)	52 (71.2)	556 (80.1)
Moderate	132 (17.2)	15 (20.5)	117 (16.9)
Severe	27 (3.5)	6 (8.2)	21 (3.0)
Priority of surgery				0.259
Elective, n (%)	763 (99.6)	72 (98.6)	691 (99.7)
Urgent, n (%)	2 (0.3)	1 (1.4)	1 (0.1)
Emergent, n (%)	1 (0.1)	0 (0)	1 (0.1)
Complexity				0.041
1 coronary procedure, n (%)	150 (19.6)	20 (27.4)	130 (18.7)
1 non-coronary procedure, n (%)	400 (52.2)	22 (30.1)	378 (54.5)
2 procedures, n (%)	191 (24.9)	25 (34.2)	166 (23.9)
3 or more procedures, n (%)	26 (3.4)	6 (8.2)	20 (2.9)
Euro Score	1.39 ± 0.9	1.87 ± 0.1	1.34 ± 0.9	<0.001

DM- diabetes mellitus; CCS- Canadian Cardiovascular Society.

Table 2. Observed and predicted mortality based on the risk category and surgery category.

	Observed mortality N (%)	Predicted mortality (%) Median (Q1,Q3)
Total Sample (n = 767)	73 (9.5%)	1.13 (0.80, 1.62)
Euroscore stratification
Very low risk, <1 (n = 330)	11 (3.3%)	0.75 (0.67, 0.84)
Low risk, 1–2.99, (n = 393)	53 (13.5%)	1.28 (1.54, 1.84)
Moderate risk, 3–4.99 (n = 36)	7 (19.4%)	3.58 (3.23, 3.92)
High risk, >5, (n-8)	2 (25%)	5.67 (5.37, 5.99)
Surgery Category
CABG (n = 159)	18 (11.3%)	1.28 (1.28, 1,28)
Valve or congenital (n = 534)	41 (7.7%)	0.96 (0.69, 1.67)
Mixed (n = 71)	14 (19.7%)	1.12 (0.81, 1.62)

CABG- Coronary artery bypass graft; Q1 – first quartile; Q3 – third quartile.

Figure 1. ROC Curve for EuroSCORE II.

Figure 2. Calibration curve of EuroSCORE II.

Table 3. Calibration and discrimination of European system for cardiac operative risk evaluation.

Group	Hosmer-Lemeshow Chi Square	p-HL	AUC	95%CI	p-AUC
Total Sample (n = 767)	31.305	0.000	0.71	0.65–0.77	0.000
Euroscore stratification
Very low risk, <1 (n = 330)	10.17	0.253	0.67	0.50–0.84	0.057
Low risk, 1–2.99, (n = 393)	12.63	0.125	0.59	0.51–0.68	0.033
Moderate risk, 3–4.99 (n = 36)	8.602	0.283	0.42	0.22–0.63	0.536
High risk, >5, (n-8)	8.414	0.209	0.33	0.00–0.85	0.264
Surgery Category
CABG (n = 159)	11.59	0.171	0.73	0.62–0.84	0.057
Valve or congenital (n = 534)	22.95	0.003	0.70	0.63–0.77	0.036
Mixed (n = 71)	3.82	0.873	0.75	0.60–0.90	0.005

CI- confidence interval; CABG- Coronary artery bypass graft; AUC – Area under the curve.