title: The validity of the original EuroSCORE and EuroSCORE II in patients over the age of seventy.
abstract: OBJECTIVE
  EuroSCORE II, despite improving on the original EuroSCORE system, has not solved all the calibration and predictability issues. We investigated the sensitivity, specificity and predictability of original EuroSCORE and EuroSCORE II system in elderly patients.
  
  
  METHODS
  The original logistic EuroSCORE and EuroSCORE II were assessed via receiver operator characteristic (ROC) and Hosmer-Lemeshow test probability analysis with regard to accuracy of predicting in-hospital mortality. Analysis was performed on isolated coronary artery bypass graft (CABG) (n = 2913), aortic valve replacement (AVR) (n = 814), mitral valve surgery (MVR) (n = 340), combined AVR and CABG cases (n = 517) and the above cases combined (n = 4584). Elderly was defined as ≥70 years old. Age <70 was used for comparative purposes.
  
  
  RESULTS
  Institutional mortality was 2.9%, for all isolated CABG, AVR, MVR and combined AVR and CABG cases. In all patients aged ≥70 neither the original EuroSCORE nor EuroSCORE II had a ROC c-statistic above 0.7. For isolated CABG, the ROC c-statistic was not acceptable in patients ≥70 years of age, but was fine for patients under the age of 70 years. For isolated AVR the ROC c-statistic was good for patients aged less than 70 years of age for both risk models; however, the ROC was unacceptably low in patients aged ≥70 for both models. For isolated MVR, the ROC c-statistic and Hosmer-Lemeshow test probability was good for all patients regardless of age. For combined AVR and CABG, the ROC c-statistic was unacceptably low for all patients, regardless of age group using the original EuroSCORE, and in those aged ≥70 using the EuroSCORE II risk model. The original EuroSCORE had no issues with the Hosmer-Lemeshow test probability; however, EuroSCORE II had poor model predictability for all patients, P < 0.0001, and for isolated CABG, P = 0.05 and AVR, P = 0.06.
  
  
  CONCLUSIONS
  The original EuroSCORE and the EuroSCORE II risk models should be used with caution in patients aged 70 or older undergoing cardiac surgery in the modern era. Below the age of 70, both models are sensitive, specific and have good predictive power. Our work needs validation by other large groups.
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK mpoullis@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Poullis
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Pullan
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Mediratta
mesh_terms: D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D019540:Area Under Curve; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003661:Decision Support Techniques; D004739:England; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: EuroSCORE; Risk modelling