title: EuroSCORE performance in valve surgery: a meta-analysis.
abstract: BACKGROUND
  The European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed to predict immediate outcomes after adult cardiac operations, but less than 30% of the cases used to develop this score were valve procedures. We studied EuroSCORE performance in valve procedures.
  
  
  METHODS
  We performed a meta-analysis of published studies reporting the assessment of discriminatory power of the EuroSCORE by receiver operating characteristics (ROC) curve analysis in adult valve operations. A comparison of observed and predicted mortality rates was also performed.
  
  
  RESULTS
  A literature search identified 37 potentially eligible studies, and 12 were selected for meta-analysis comprising 26,621 patients with 1250 events (mortality rate, 4.7%). Meta-analysis of these studies provided an average area under the curve (AUC) value of 0.730 (95% confidence interval [CI], 0.717 to 0.743). The same results were obtained when meta-analyses were performed separately in studies categorized on reliability of uncertainty estimation: in the seven studies reporting reliable uncertainty estimation (8175 patients with 358 events; mortality rate, 4.4%), the ROC curve provided an average AUC value of 0.724 (95% CI, 0.699 to 0.749). The five studies not reporting reliable uncertainty estimation (18,446 patients with 892 events; mortality rate, 4.8%) had an average AUC of 0.732 (95% CI, 0.717 to 0.747). We documented a constant trend to overpredict mortality by EuroSCORE, both in the additive and especially in the logistic form.
  
  
  CONCLUSIONS
  The EuroSCORE has low discrimination ability for valve surgery, and it sensibly overpredicts risk. Alternative risk scoring algorithms should be seriously considered.
authors.affiliation: Department of Cardiac Surgery, Unit for Clinical Research in Atherothrombosis, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy. alessandro.parolari@cardiologicomonzino.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.forename: Lorenzo L
authors.initials: LL
authors.lastname: Pesce
authors.forename: Matteo
authors.initials: M
authors.lastname: Trezzi
authors.forename: Laura
authors.initials: L
authors.lastname: Cavallotti
authors.forename: Samer
authors.initials: S
authors.lastname: Kassem
authors.forename: Claudia
authors.initials: C
authors.lastname: Loardi
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
mesh_terms: D000328:Adult; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D001026:Coronary Artery Bypass; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D012372:ROC Curve; D018570:Risk Assessment