Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

Franzotti, Silvana Alves dos Santos; Sloboda, Dyenily Alessi; Silva, Juliana Rosendo; Souza, Ellian Amorim Santos; Reboreda, Jessica Zamora; Ferretti-Rebustini, Renata Eloah de Lucena; Nogueira, Lilia de Souza

doi:10.36660/abc.20190120

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Original Article • Arq. Bras. Cardiol. 115 (3) • Sept 2020 • https://doi.org/10.36660/abc.20190120 copy

Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Patients in the postoperative period of myocardial revascularization (Coronary Artery Bypass Grafting - CABG) surgery admitted to the intensive care unit (ICU) are at risk of complications which increase the length of stay and morbidity and mortality. Therefore, early recognition of these risks is essential to optimize prevention strategies and a satisfactory clinical outcome.

Objective

To analyze the performance of severity indices in predicting complications in patients in the postoperative of CABG during the ICU stay.

Methods

A cross-sectional study with retrospective analysis of electronic medical records of patients aged ≥ 18 years who underwent isolated CABG and were admitted to the ICU of a cardiology hospital in São Paulo, Brazil. The areas under the receiver operating characteristic curves (AUC) with a 95% confidence interval were analyzed to verify the accuracy of the European System for Cardiac Operative Risk Evaluation (EuroScore), Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) indices in predicting complications.

Results

The sample consisted of 366 patients (64.58 ± 9.42 years; 75.96% male). The complications identified were: respiratory (24.32%), cardiovascular (19.95%), neurological (10.38%), hematological (10.38%), infectious (6.56%) and renal (3.55%). APACHE II showed satisfactory performance for predicting neurological (AUC 0.72) and renal (AUC 0.78) complications.

Conclusion

APACHE II excelled in predicting neurological and renal complications. None of the indices performed well in predicting the other analyzed complications. Therefore, severity indices should not be used indiscriminately in order to predict all complications frequently presented by patients after CABG. (Arq Bras Cardiol. 2020; 115(3):452-459)

Cardiovascular Diseases/complications; Cardiovascular Diseases/surgery; Myocardial Revascularization/complications; Postoperative Care; Indicators of Morbidity and Mortality; Severity of Illness Index; Intensive Care Units

Severity index	Mean	Standard deviation	Median	Min-Max
EuroScore*	4.08	4.70	2.50	0.88 - 29.29
SOFA†	5.84	1.88	6.00	2.00 - 13.00
APACHE II‡	14.21	4.96	14.00	4.00 - 41.00
SAPS II§	24.37	8.66	24.00	7.00 - 54.00

Neurological	AUC^//	95%CI^¶ min-max	Cut-off point	Sensitivity	Specificity	PPV^#	NPV^**	Accuracy
EuroScore*	0.66	0.57-0.74	2.59	73.68	55.05	16.00	94.74	56.99
SOFA^†	0.65	0.55-0.74	6.50	57.89	70.34	18.49	93.50	69.04
APACHE II^‡	0.72	0.63-0.81	15.50	71.05	67.89	20.45	95.28	68.22
SAPS II^§	0.66	0.57-0.75	23.50	76.32	49.24	14.87	94.71	52.05
Cardiovascular	AUC//	95%CI^¶ min-max	Cut-off point	Sensitivity	Specificity	PPV^#	NPV**	Accuracy
EuroScore*	0.65	0.58-0.72	3.50	52.05	71.58	31.40	85.66	67.67
SOFA^†	0.63	0.56-0.70	5.50	72.60	49.32	26.37	87.80	53.97
APACHE II^‡	0.60	0.52-0.67	17.50	34.25	81.51	31.65	83.22	72.05
SAPS II^§	0.67	0.60-0.74	27.50	57.53	71.23	33.33	87.03	68.49
Infectious	AUC^//	95%CI^¶ min-max	Cut-off point	Sensitivity	Specificity	PPV^#	NPV**	Accuracy
EuroScore*	0.66	0.56-0.78	1.92	91.67	39.00	9.57	98.52	42.47
SOFA^†	0.64	0.52-0.74	6.50	58.33	69.21	11.76	95.93	68.49
APACHE II^‡	0.58	0.46-0.70	17.50	41.67	79.77	12.66	95.10	77.26
SAPS II^§	0.63	0.53-0.74	25.50	66.67	58.06	10.06	96.12	58.63
Respiratory	AUC^//	95%CI^¶ min-max	Cut-off point	Sensitivity	Specificity	PPV^#	NPV**	Accuracy
EuroScore*	0.58	0.51-0.64	1.92	75.00	40.79	28.70	83.70	49.04
SOFA^†	0.61	0.54-0.67	5.50	68.18	49.10	29.85	82.93	53.70
APACHE II^‡	0.59	0.52-0.66	14.50	57.95	60.65	31.87	81.95	60.00
SAPS II^§	0.65	0.58-0.71	27.50	53.41	71.48	37.30	82.85	67.12
Renal	AUC^//	95%CI^¶ min-max	Cut-off point	Sensitivity	Specificity	PPV^#	NPV**	Accuracy
EuroScore*	0.74	0.62-0.86	2.65	84.62	54.83	6.47	98.97	55.89
SOFA^†	0.73	0.59-0.87	7.50	53.85	82.67	10.29	97.98	81.64
APACHE II^‡	0.78	0.63-0.93	17.50	76.92	80.40	12.66	98.95	80.27
SAPS II^§	0.64	0.48-0.80	26.50	69.23	61.65	6.25	98.19	61.92
Hematological	AUC^//	95%CI^¶ min-max	Cut-off point	Sensitivity	Specificity	PPV^#	NPV**	Accuracy
EuroScore*	0.57	0.48-0.67	1.52	71.87	47.37	92.16	16.36	69.32
SOFA^†	0.57	0.47-0.67	6.50	44.74	68.81	14.29	91.46	66.30
APACHE II^‡	0.55	0.45-0.65	14.50	52.63	57.19	12.50	91.22	56.71
SAPS II^§	0.60	0.50-0.68	21.50	76.32	40.06	12.89	93.57	43.84

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