(Circulation. 1999;99:2378-2382.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Mortality Prediction in Cardiac Surgery Patients
Comparative Performance of Parsonnet and General Severity Systems
From the Department of Critical Care (J.M.-A., E.P., M.S., M.L.M.) and the Department of Cardiovascular Surgery (I.D.T.), Hospital Universitario de Canarias, Spain.
Correspondence to Dr Ignacio Díaz de Tuesta, Servicio de Cirugía Cardiaca, Hospital Universitario de Canarias, 38320 La Laguna, SC Tenerife, Spain. E-mail tuesta{at}usa.net
Background—Our purpose was to assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE], Simplified Acute Physiology Score [SAPS], and Mortality Probability Models [MPM]) and to compare them with the Parsonnet score to predict mortality after cardiac surgery.
Methods and Results—This was a prospective observational study of
465 cardiac surgery patients in a tertiary referral center.
Probabilities of hospital death for patients were estimated by applying
the 4 models and were compared with actual mortality rates.
Performance of the 4 systems was assessed by evaluating
calibration with the Hosmer-Lemeshow goodness-of-fit test and
discrimination with receiver operating characteristic (ROC) curves.
2 values were 3.71 for Parsonnet, 4.52 for MPM
II0, 4.30 for MPM II24, 5.16 for SAPS II, and
10.57 for APACHE II. The area under the ROC curve was 0.857 for
Parsonnet, 0.783 for MPM II0, 0.796 for MPM
II24, 0.771 for SAPS II, and 0.803 for APACHE II.
Conclusions—In our experience, the Parsonnet score performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool to assess mortality in cardiac surgery patients. In our experience, the general severity systems perform well to predict mortality after cardiac surgery, with high calibration of MPM II24, MPM II0, and SAPS II; minor calibration for APACHE II; and high discrimination for 3 general systems, but not as well as the Parsonnet score.
Key Words: surgery • mortality • risk factors
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