title: Assessment of Euroscore and SAPS III as hospital mortality predicted in cardiac surgery.
abstract: OBJECTIVE
  To perform an external validation of Euroscore I, Euroscore II and SAPS III.
  
  
  METHODS
  Retrospective cohort study over three years on all adult patients who underwent cardiac surgery. We reviewed the clinical data, following the patient until outcome or discharge from hospital (dead, alive). We computed the predicted mortality by Euroscore I (EI), II (EII) and SAPS III. The model validation was assessed by discrimination: area under curve ROC; and calibration (Hosmer-Lemeshow test).
  
  
  RESULTS
  866 patients were included. 62.5% of them male, with a median age of 69 years, 6.1% died during hospitalization. Predicted mortality: E I 7.94%, E II 3.54, SAPS III 12.1%. Area under curve (95% IC): E I 0.862 (0.812-0.912); E II 0.861 (0.806-0.915); SAPS III 0.692 (0.601-0.784). Hosmer-Lemeshow test: E I 14.0046 (P=.08164); E II 33.67 (P=.00004660); SAPS III 11.57 (P=.171).
  
  
  CONCLUSIONS
  EII had good discrimination, but the calibration was not good with predicted mortality lower than the real mortality. E I showed the best discrimination with good calibration and a tendency to overestimate the mortality. SAPS III showed poor discrimination with good calibration and a tendency to greatly overestimate the predicted mortality. We saw no improvement in the predictive performance of EII over I and we reject the use of SAPS III in this kind of patient.
authors.affiliation: Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España.
authors.forename: B
authors.initials: B
authors.lastname: Mateos-Pañero
authors.affiliation: Unidad de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España. Electronic address: mmsc16@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Casado
authors.affiliation: Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España.
authors.forename: B
authors.initials: B
authors.lastname: Castaño-Moreira
authors.affiliation: Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España.
authors.forename: I
authors.initials: I
authors.lastname: Paredes-Astillero
authors.affiliation: Cirugía Cardiaca, Hospital Virgen de la Salud, Toledo, España.
authors.forename: L F
authors.initials: LF
authors.lastname: López-Almodóvar
authors.affiliation: Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España.
authors.forename: F
authors.initials: F
authors.lastname: Bustos-Molina
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D000072878:Simplified Acute Physiology Score
keywords: Cardiac surgery; Cirugía cardiaca; Escalas pronósticas; Euroscore I; Euroscore II; Mortalidad; Mortality; Prognostic score; SAPS III