Logistic or additive EuroSCORE for high-risk patients?
OBJECTIVE
To assess whether the use of the full logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) is superior to the standard additive EuroSCORE in predicting mortality in high-risk cardiac surgical patients.


METHODS
Both the simple additive EuroSCORE and the full logistic EuroSCORE were applied to 14,799 cardiac surgical patients from across Europe, of whom there were 4293 high-risk patients (additive EuroSCORE of 6 or more). The systems were compared for absolute prediction and discrimination (area under the receiver operating characteristic (ROC) curve).


RESULTS
Actual mortality was 4.72%. The logistic model was closer to this than the additive model (4.84% (4.72-4.94) versus 4.21 (4.21-4.26)). Most of this difference was due to high-risk patients where actual mortality was 11.18% and predicted was 7.83% (additive) and 11.23% (logistic). Discrimination was similar in both systems as measured by the area under the ROC curve (additive 0.783, logistic 0.785).


CONCLUSIONS
The additive EuroSCORE model remains a simple "gold standard" for risk assessment in European cardiac surgery, usable at the bedside without complex calculations or information technology. The logistic model is a better risk predictor especially in high-risk patients and may be of interest to institutions engaged in the study and development of risk stratification.
Michel
Philippe
P
University of Bordeaux, Bordeaux, France.
Roques
Francois
F
Nashef
Samer A M
SA
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment / Q000592:standards*; D012307:Risk Factors; D016019:Survival Analysis