title: Clinical performance of the EuroSCORE II compared with the previous EuroSCORE iterations.
abstract: BACKGROUND
  The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II has been recently introduced as an update to the previous versions. We sought to evaluate the predictive performance of the EuroSCORE II model against the original additive and logistic EuroSCORE models.
  
  
  METHODS
  The study included 1,247 consecutive patients who underwent cardiac surgery procedures during a 14-month period starting from the beginning of 2012. The original additive and logistic EuroSCORE models were compared with the EuroSCORE II focusing on the accuracy of predicting hospital mortality.
  
  
  RESULTS
  The overall hospital mortality rate was 3.45%. The discriminative power of the EuroSCORE II was modest and similar to other algorithms (C-statistics 0.754 for additive EuroSCORE; 0.759 for logistic EuroSCORE; and 0.743 for EuroSCORE II). The EuroSCORE II significantly underestimated the all-patient hospital mortality (3.45% observed vs. 2.12% predicted), as well as in the valvular (3.74% observed vs. 2% predicted), and combined surgery cohorts (6.87% observed vs. 3.64% predicted). The predicted EuroSCORE mortality significantly differed from the observed mortality in the third and the fourth quartile of patients stratified according to the EuroSCORE II mortality risk (p < 0.05). The calibration of the EuroSCORE II was generally good for the entire patient population (Hosmer-Lemeshow [HL] p = 0.139), for the valvular surgery subset (HL p = 0.485), and for the combined surgery subset (HL p = 0.639).
  
  
  CONCLUSIONS
  The EuroSCORE II might be considered a solid predictive tool for hospital mortality. Although, the EuroSCORE II employs more sophisticated calculation methods regarding the number and definition of risk factors included, it does not seem to significantly improve the performance of previous iterations.
authors.affiliation: Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
authors.forename: Lazar
authors.initials: L
authors.lastname: Velicki
authors.affiliation: Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Cemerlic-Adjic
authors.affiliation: Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
authors.forename: Katica
authors.initials: K
authors.lastname: Pavlovic
authors.affiliation: Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Bojan B
authors.initials: BB
authors.lastname: Mihajlovic
authors.affiliation: Department of Mathematics, State University of Novi Pazar, Novi Pazar, Serbia.
authors.forename: Dragic
authors.initials: D
authors.lastname: Bankovic
authors.affiliation: Department of Surgery, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
authors.forename: Bogoljub
authors.initials: B
authors.lastname: Mihajlovic
authors.affiliation: Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Miklos
authors.initials: M
authors.lastname: Fabri
mesh_terms: D000368:Aged; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome