Validation of the European System for Cardiac Operative Risk Evaluation-II model in an urban Indian population and comparison with three other risk scoring systems
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The aims were to compare the European System for Cardiac Operative Risk Evaluation (EuroSCORE)-II system against three established risk scoring systems for predictive accuracy in an urban Indian population and suggest improvements or amendments in the existing scoring system for adaptation in Indian population.EuroSCORE-II, Parsonnet score, System-97 score, and Cleveland score were obtained preoperatively for 1098 consecutive patients. EuroSCORE-II system was analyzed in comparison to each of the above three scoring systems in an urban Indian population. Calibrations of scoring systems were assessed using Hosmer-Lemeshow test. Areas under receiver operating characteristics (ROC) curves were compared according to the statistical approach suggested by Hanley and McNeil.All EuroSCORE-II subgroups had highly significant P values stating good predictive mortality, except high-risk group (P = 0.175). The analysis of ROC curves of different scoring systems showed that the highest predictive value for mortality was calculated for the System-97 score followed by the Cleveland score. System-97 revealed extremely high predictive accuracies across all subgroups (curve area >80%). This difference in predictive accuracy was found to be statistically significant (P < 0.001).The present study suggests that the EuroSCORE-II model in its present form is not validated for use in the Indian population. An interesting observation was significantly accurate predictive abilities of the System-97 score.Keywords:
EuroSCORE
Predictive modelling
Although several chest X-ray (CXR) severity scoring systems are in use to assess Covid-19 pneumonia (CP), inhomogeneity has been observed among the assessment methodologies.To describe and validate severity scoring system based on different features to identify the most suitable scoring system to predict CP severity and outcome.This retrospective study examined CXRs (n=147) of CP patients (n=85) to calculate severity scores using three scoring systems based on area infiltrated and the density patterns: A, A&D, and New. The best scoring system to predict the mortality was identified using the area under the curve (AUC) and linear regression analysis.Regardless of the scoring system used, CXR severity has shown a good correlation to clinical CP severity (A: χ2=6.745; p =0.034; A&D: χ2=12.404; p =0.002; New: χ2=10.219; p =0.006). The mortality predictability of all scoring systems were satisfactory with high AUC ("A": AUC=0.685, sensitivity:67.4%, specificity:54.5% at a cut-off point of 5/8; positive predictive value (PPV): 40.3%, negative predictive value (NPV):78.6%"; A&D": AUC=0.748, sensitivity:69.6%, specificity:61.4% at a cut-off point of 7/16, PPV:45.1%, NPV:81.6%; "New": AUC=0.727; p ≤ 0.001, sensitivity:67.4%, specificity:68.3% at a cut-off point of 18/48, PPV:49.2%, NPV:82.1%). Additionally, the mortality predicting ability of the "New" scoring system was significantly higher than the other two systems (OR:2.897; CI [1.071-7.8.36]; p=0.036).Covid-19 pneumonia severity assessed with the CXR severity scoring systems correlated significantly with clinical severity and outcome. Overall, the "New" CXR severity scoring system is comparatively better at predicting the mortality of Covid-19 pneumonia.
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Nephrology
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The aims were to compare the European System for Cardiac Operative Risk Evaluation (EuroSCORE)-II system against three established risk scoring systems for predictive accuracy in an urban Indian population and suggest improvements or amendments in the existing scoring system for adaptation in Indian population.EuroSCORE-II, Parsonnet score, System-97 score, and Cleveland score were obtained preoperatively for 1098 consecutive patients. EuroSCORE-II system was analyzed in comparison to each of the above three scoring systems in an urban Indian population. Calibrations of scoring systems were assessed using Hosmer-Lemeshow test. Areas under receiver operating characteristics (ROC) curves were compared according to the statistical approach suggested by Hanley and McNeil.All EuroSCORE-II subgroups had highly significant P values stating good predictive mortality, except high-risk group (P = 0.175). The analysis of ROC curves of different scoring systems showed that the highest predictive value for mortality was calculated for the System-97 score followed by the Cleveland score. System-97 revealed extremely high predictive accuracies across all subgroups (curve area >80%). This difference in predictive accuracy was found to be statistically significant (P < 0.001).The present study suggests that the EuroSCORE-II model in its present form is not validated for use in the Indian population. An interesting observation was significantly accurate predictive abilities of the System-97 score.
EuroSCORE
Predictive modelling
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There is uncertainty about the clinical usefulness of currently available asthma predictive tools. Validation of predictive tools in different populations and clinical settings is an essential requirement for the assessment of their predictive performance, reproducibility and generalizability. We aimed to critically appraise asthma predictive tools which have been validated in external studies.We searched MEDLINE and EMBASE (1946-2017) for all available childhood asthma prediction models and focused on externally validated predictive tools alongside the studies in which they were originally developed. We excluded non-English and non-original studies. PROSPERO registration number is CRD42016035727.From 946 screened papers, eight were included in the review. Statistical approaches for creation of prediction tools included chi-square tests, logistic regression models and the least absolute shrinkage and selection operator. Predictive models were developed and validated in general and high-risk populations. Only three prediction tools were externally validated: the Asthma Predictive Index, the PIAMA and the Leicester asthma prediction tool. A variety of predictors has been tested, but no studies examined the same combination. There was heterogeneity in definition of the primary outcome among development and validation studies, and no objective measurements were used for asthma diagnosis. The performance of tools varied at different ages of outcome assessment. We observed a discrepancy between the development and validation studies in the tools' predictive performance in terms of sensitivity and positive predictive values.Validated asthma predictive tools, reviewed in this paper, provided poor predictive accuracy with performance variation in sensitivity and positive predictive value.
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Most cardiac surgery risk stratification systems were primarily designed using patient-related factors to predict mortality and postoperative morbidity. Relative mortality rates are higher at cardiac surgery centers which perform surgery on elderly patients. Our aim was to assess the validity of risk stratification systems for our regional population.The study involved 1021 patients. Risk stratification was carried out using the EuroSCORE, Ontario, and QMMI scoring systems. Analysis comparing the scoring systems included sensitivity, specificity, predictive values, and receiver operating characteristics (ROC) curves. Accuracy was assessed using the systems' ability to avoid Type I and Type II errors.Sensitivity and specificity of the QMMI scoring system were 33.3% and 97.2%, of EuroSCORE 20.7% and 96.7%, and of Ontario 21.1% and 94.4%, respectively. The best positive predictive value was for QMMI and EuroSCORE with 75% versus Ontario's 50%. The highest negative predictive value was QMMI's 85.4% versus Ontario's 78.9% and EuroSCORE's 72.0%. The best accuracy showed QMMI scoring with 84.5% versus Ontario's 78.9% and EuroSCORE's 72.2%.All the investigated risk stratification systems were moderately predictive. The QMMI score showed the best predictive characteristics (sensitivity, specificity, and accuracy) for our patient population. The QMMI system had high specificity and accuracy. The EuroSCORE system showed mortality overprediction for our population, associated with high false negative test results and low accuracy. The Ontario risk stratification system often commits Type II errors, associated with a high rate of false positive test results and low accuracy.
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Abstract Background Higher EuroSCORE II values are usually associated with increased postoperative morbidity and longer durations of Cardiac intensive care unit (CICU) stay following cardiac surgery. Aim/Purpose The aim is to investigate the predictive performance of EuroSCORE II for the Indian population and its relationship with ICU length of stay. Methods Prospective, observational study in 250 adult cardiac patients undergoing CABG under general Anaesthesia. Preoperatively values of EuroSCORE II was calculated by an online calculator available on www.euroscore.org . These patients were followed up after surgery for 30 days to note mortality and length of CICU stay. Results Of 250 cases studied, 39 (15.6%) had EuroSCORE II less than 1, 163 (65.2%) had EuroSCORE II between 1 and 3, 36 (14.4%) had EuroSCORE II between 3.1 and 5.0 and 12 (4.8%) had EuroSCORE II more than 5 in the study group. Mean EuroSCORE II and length of stay in CICU after surgery was 2.2 ± 1.4 and 4.2 ± 2.5 days respectively. The area under the curve (AUC) for EuroSCORE II as a sole predictor of mortality in the study group based on receiver operating characteristic curve (ROC) analysis was 0.919 (95% CI 0.86–0.97). Based on ROC analysis, AUC is significantly higher for predicting mortality ( p < 0.001). Conclusion EuroSCORE II in Indian cardiac patients undergoing cardiac surgery is lesser than in European patients (mean 2.2 vs 3.7). Incidence of mortality is higher in patients with higher EuroSCORE II. As per our study patients with higher EuroSCORE II tend to stay longer in ICU.
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To assess the value of European system for cardiac operative risk evaluation (EuroSCORE) in predicting quality of life in patients post coronary artery bypass graft surgery (CABG).A total of 387 patients underwent CABG in our institute from December of 2002 to December of 2007 were assessed by EuroSCORE before operation. Health-related quality of life (QoL) was estimated postoperatively with Seattle angina questionnaire (SAQ), Nottingham healthy profile (NHP) and Duke activity status index (DASI) in order to evaluate the value of EuroSCORE for predicting quality of life in patients post CABG.There were statistically significant but weak correlations between postoperative QoL score and preoperative EuroSCORE score (r: 0.010 - 0.276). Emotional and psychological experience subgroup analysis showed better predictive value of EuroSCORE score on postoperative QoL score in improved physical functioning subgroups (r > 0.2). Linear regression analysis showed that EuroSCORE score was significant but weakly (r(2) < 0.1) correlated with postoperative QoL score (P < 0.05).Preoperative EuroSCORE score is weakly correlated with postoperative QoL score in patients post CABG.
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Canadian Cardiovascular Society
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