title: Validation of the Intensive Care National Audit and Research Centre Scoring System in a UK Adult Cardiac Surgery Population.
abstract: OBJECTIVE
  The Intensive Care National Audit and Research Centre (ICNARC) scoring system was conceived in 2007, utilizing 12 physiologic variables taken from the first 24 hours of adult admissions to the general intensive care unit (ICU) to predict in-hospital mortality. The authors aimed to evaluate the ICNARC score in predicting mortality in cardiac surgical patients compared to established cardiac risk models such as logistic EuroSCORE as well as to the Acute Physiology and Chronic Health Evaluation (APACHE) II.
  
  
  METHODS
  Retrospective analysis of data collected prospectively.
  
  
  METHODS
  Single-center study in a cardiac intensive care in a regional cardiothoracic center.
  
  
  METHODS
  Patients undergoing cardiac surgery between January 2010 and June 2012.
  
  
  METHODS
  A total of 1,646 patients were scored preoperatively using the logistic EuroSCORE and postoperatively using ICNARC and APACHE II. Data for comparison of scoring systems are presented as area under the receiver operating characteristic curve.
  
  
  RESULTS
  The mean age at surgery was 67 years±10.1. The mortality from all cardiac surgery was 3.2%. The mean logistic EuroSCORE was 7.31±10.13, the mean ICNARC score was 13.42±5.055, while the mean APACHE II score was 6.32±7.731. The c-indices for logistic EuroSCORE, ICNARC, and APACHE II were 0.801, 0.847 and 0.648, respectively.
  
  
  CONCLUSIONS
  The authors have, for the first time, validated the ICNARC score as a useful predictor of postoperative mortality in adult cardiac surgical patients. This could have implications for postoperative management, focusing the utilization of resources as well as a method to measure and compare performance in the cardiothoracic ICU.
authors.affiliation: Department of Cardiothoracic Surgery. Electronic address: priyadariyaratnam@yahoo.co.uk.
authors.forename: Priyadharshanan
authors.initials: P
authors.lastname: Ariyaratnam
authors.affiliation: Department of Cardiothoracic Surgery.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Loubani
authors.affiliation: Department of Cardiothoracic Anaesthesia Castle Hill Hospital, Cottingham, UK.
authors.forename: James
authors.initials: J
authors.lastname: Biddulph
authors.affiliation: Department of Cardiothoracic Anaesthesia Castle Hill Hospital, Cottingham, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Moore
authors.affiliation: Department of Cardiothoracic Surgery.
authors.forename: Neil
authors.initials: N
authors.lastname: Richards
authors.affiliation: Department of Cardiothoracic Surgery.
authors.forename: Mubarak
authors.initials: M
authors.lastname: Chaudhry
authors.affiliation: Department of Cardiothoracic Anaesthesia Castle Hill Hospital, Cottingham, UK.
authors.forename: Vincent
authors.initials: V
authors.lastname: Hong
authors.affiliation: Department of Cardiothoracic Anaesthesia Castle Hill Hospital, Cottingham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Haworth
authors.affiliation: Department of Cardiothoracic Anaesthesia Castle Hill Hospital, Cottingham, UK.
authors.forename: Anantha
authors.initials: A
authors.lastname: Ananthasayanam
mesh_terms: D018806:APACHE; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000592:standards*; D003422:Critical Care / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011182:Postoperative Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: APACHE II; EuroSCORE; ICNARC; cardiac surgery; intensive care; risk stratification