title: The novel EuroSCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic EuroSCORE algorithms.
abstract: OBJECTIVE
  The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was developed to improve the overestimation of surgical risk associated with the original (additive and logistic) EuroSCOREs. The purpose of this study was to evaluate the significance of the EuroSCORE II by comparing its performance with that of the original EuroSCOREs in Japanese patients undergoing surgery on the thoracic aorta.
  
  
  METHODS
  We have calculated the predicted mortalities according to the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms in 461 patients who underwent surgery on the thoracic aorta during a period of 20 years (1993-2013).
  
  
  RESULTS
  The actual in-hospital mortality rates in the low- (additive EuroSCORE of 3-6), moderate- (7-11) and high-risk (≥11) groups (followed by overall mortality) were 1.3, 6.2 and 14.4% (7.2% overall), respectively. Among the three different risk groups, the expected mortality rates were 5.5 ± 0.6, 9.1 ± 0.7 and 13.5 ± 0.2% (9.5 ± 0.1% overall) by the additive EuroSCORE algorithm, 5.3 ± 0.1, 16 ± 0.4 and 42.4 ± 1.3% (19.9 ± 0.7% overall) by the logistic EuroSCORE algorithm and 1.6 ± 0.1, 5.2 ± 0.2 and 18.5 ± 1.3% (7.4 ± 0.4% overall) by the EuroSCORE II algorithm, indicating poor prediction (P < 0.0001) of the mortality in the high-risk group, especially by the logistic EuroSCORE. The areas under the receiver operating characteristic curves of the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms were 0.6937, 0.7169 and 0.7697, respectively. Thus, the mortality expected by the EuroSCORE II more closely matched the actual mortality in all three risk groups. In contrast, the mortality expected by the logistic EuroSCORE overestimated the risks in the moderate- (P = 0.0002) and high-risk (P < 0.0001) patient groups.
  
  
  CONCLUSIONS
  Although all of the original EuroSCOREs and EuroSCORE II appreciably predicted the surgical mortality for thoracic aortic surgery in Japanese patients, the EuroSCORE II best predicted the mortalities in all risk groups.
authors.affiliation: Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nishida
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Sonoda
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Oishi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tanoue
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakashima
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
mesh_terms: D000465:Algorithms; D001013:Aorta, Thoracic / Q000601:surgery*; D019540:Area Under Curve; D044466:Asian People; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D017052:Hospital Mortality / Q000208:ethnology*; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*
keywords: Aortic surgery; Hospital mortality; Risk stratification