Validation study of EuroSCORE II for dialysis patients: A single-center study in Japan

Keishiro Sueda; Eiji Hiraoka; Koichi Kitamura; Yasuhiro Norisue; Toshihiko Suzuki; Osamu Takahashi; Joji Ito; Minoru Tabata

doi:10.1016/j.jjcc.2023.09.011

Validation study of EuroSCORE II for dialysis patients: A single-center study in Japan

J Cardiol. 2023 Oct 4:S0914-5087(23)00241-1. doi: 10.1016/j.jjcc.2023.09.011. Online ahead of print.

Authors

Keishiro Sueda¹, Eiji Hiraoka², Koichi Kitamura³, Yasuhiro Norisue⁴, Toshihiko Suzuki³, Osamu Takahashi⁵, Joji Ito⁶, Minoru Tabata⁷

Affiliations

¹ Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
² Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: eijih@jadecom.jp.
³ Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
⁴ Department of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
⁵ Department of Internal Medicine, St. Luke's International Hospital, Tokyo, Japan.
⁶ Department of Cardiothoracic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
⁷ Department of Cardiothoracic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.

PMID: 37802204
DOI: 10.1016/j.jjcc.2023.09.011

Abstract

Background: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II is a predictive model for in-hospital mortality after cardiac surgery. Although it has good performance among the general population undergoing cardiac surgery, it has not been validated among dialysis patients, who have a higher rate of mortality after cardiac surgery. This study aimed to evaluate the performance of the model in predicting in-hospital mortality in maintenance dialysis patients undergoing cardiac surgery.

Methods: This retrospective, single-center study included adult patients on maintenance dialysis who underwent open cardiac surgery at our institution. Calibration performance of EuroSCORE II for in-hospital death was determined based on the comparison between expected and observed mortalities for low- (EuroSCORE II <4 %), intermediate- (4-8 %), and high-risk (>8 %) groups. The area under receiver operating characteristic curve (AUROC) was investigated to determine the model's discrimination performance.

Results: A total of 163 patients (male, 73.6 %; median age, 70 years; median dialysis vintage, 9 years; median EuroSCORE II, 3.3 %) were included. The mortality rate was 9.2 %. The observed mortality rates (vs. mean expected mortality) rates were 2.1 % (vs. 2.4 %), 7.5 % (vs. 5.5 %), and 34.5 % (vs. 21.1 %) in the low-, intermediate-, and high-risk groups, respectively. Its AUROC was 0.825 (95 % confidence interval, 0.711-0.940).

Conclusions: Although EuroSCORE II model adequately estimated in-hospital mortality in the low-and intermediate-risk groups (EuroSCORE II <8 %), it underestimated in-hospital mortality in the high-risk group (EuroSCORE II >8 %) among maintenance dialysis patients. The discrimination performance of the model for in-hospital death was good among maintenance dialysis patients.

Keywords: Cardiac surgery; Dialysis; End-stage renal disease; EuroSCORE II; Japan.