Validation of EuroSCORE II in Spain

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Introduction: EuroSCORE has been the predictive model of choice for surgical mortality since the late 1990's, although several studies have shown a progressive loss of calibration. This led to the development of EuroSCORE II, a new version of the model. The aim of the study was to design and conduct a national validation study. Methods: A prospective and multicenter study was designed based on volunteer participation. Data regarding EuroSCORE and EuroSCORE II, and observed mortality were acquired. Data were refined to obtain an actual rate of loss, or incoherent, data of 0%. The calibration of the models was evaluated with the Hosmer-Lemeshow goodness-of-fit test, and discrimination with the area under the ROC curve. Results: A total of 20 Spanish centres participated in this study, with 4034 patients recruited between 1 October 2012 and 31 March 2013. Risk factor prevalence was analysed. Observed mortality was 6.5%. The mean values for additive and logistic EuroSCORE and EuroSCORE II were 6.5, 9.8% and 5.7%, respectively. Areas under the ROC curves were EuroSCORE: 0.77 (95% CI; 0.74-0.80), EuroSCORE II: 0.79 (95% CI; 0.76-0.82). Results for the goodness-of-fit test were EuroSCORE: 33.02 (P<.001), EuroSCORE II: 38.98 (P<.001). Conclusions: The risk profile in Spanish patients is high. Crude mortality is acceptable, closer to the value predicted by EuroSCORE II than by EuroSCORE. Both models show failure in calibration; EuroSCORE by over-prediction and EuroSCORE II by under-prediction of surgical risk. Areas under the ROC curve show good discrimination for both models.




García-Valentín, A., Bernabeu, E., Pereda, D., Josa, M., Cortina, J. M., Mestres, C. A., … Carrascal, Y. (2014). Validation of EuroSCORE II in Spain. Cirugia Cardiovascular, 21(4), 246–251.

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