title: EuroSCORE models in a cohort of patients with valvular heart disease and a high prevalence of rheumatic fever submitted to surgical procedures.
abstract: OBJECTIVE
  Epidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery.
  
  
  METHODS
  Between 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  The mean age was 56 ± 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery). Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70-0.81) for the additive EuroSCORE, 0.76 (95% CI 0.70-0.81) for the logistic EuroSCORE and 0.81 (95% CI 0.76-0.86) for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II.
  
  
  CONCLUSIONS
  In this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate.
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Casalino
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Flávio
authors.initials: F
authors.lastname: Tarasoutchi
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Spina
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bacelar
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Roney
authors.initials: R
authors.lastname: Sampaio
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Otavio T
authors.initials: OT
authors.lastname: Ranzani
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Pomerantzeff
authors.affiliation: Heart Institute-University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012372:ROC Curve; D012213:Rheumatic Fever / Q000150:complications*; D012307:Risk Factors