This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ruyun Jin Gary L. Grunkemeier Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jin, R. Articles by Grunkemeier, G. L. Search for Related Content PubMed PubMed Citation Articles by Jin, R. Articles by Grunkemeier, G. L. Related Collections Cardiac - other

Does the logistic EuroSCORE offer an advantage over the additive model?

For the Providence Health System Cardiovascular Study Group, Providence Health System, Portland, Oregon, USA

*Corresponding author: Ruyun Jin, MD, Providence St. Vincent Hospital and Medical Center, 9205 SW Barnes Road, LL#33, Portland, Oregon 97225, USA. Tel.: +1-503-216-7276; fax: +1-503-216-7274.

E-mail address: Ruyun.Jin{at}providence.org (R. Jin).

There are two versions of the EuroSCORE cardiac surgery risk model for mortality: the logistic regression which provides a predicted probability of death, and an additive score, a simplified approximation to the logistic probability, which can be easily calculated without a computing aid. A recent comparison of these two models' performance concluded that the logistic probability did not offer a distinct advantage over the additive score, and that the additive score was just as accurate as the logistic probability, even in high-risk patients. This conflicts with the conclusion of our previous study of the same issue. Thus, we did further analyses of our original data, following the approach of these authors. The additive and logistic EuroSCORE models were retrospectively applied to predict operative mortality in 23,463 cardiac surgery patients operated from 1997–2004 at Providence Health System hospitals. Both the logistic and additive risk predictions are higher than the observed mortality, and were calibrated downward to reconcile this difference. The observed-to-predicted ratio is relatively constant for the logistic model, but it varies with the risk score for the additive model. Thus, the logistic model can be recalibrated to fit the actual outcome well, but the recalibrated additive model cannot. The (recalibrated) logistic model is more accurate for different patient groups, including the high-risk patients, and should be preferred for clinical use.

Key Words: Logistic model; Additive model; EuroSCORE; Cardiac surgery; Mortality

This article has been cited by other articles:

				M. Ranucci, S. Castelvecchio, L. A. Menicanti, S. Scolletta, B. Biagioli, and P. Giomarelli An adjusted EuroSCORE model for high-risk cardiac patients Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 791 - 797. [Abstract] [Full Text] [PDF]

				M. Ranucci, S. Castelvecchio, L. Menicanti, A. Frigiola, and G. Pelissero Risk of Assessing Mortality Risk in Elective Cardiac Operations: Age, Creatinine, Ejection Fraction, and the Law of Parsimony Circulation, June 23, 2009; 119(24): 3053 - 3061. [Abstract] [Full Text] [PDF]

				A. Parolari, L. L. Pesce, M. Trezzi, C. Loardi, S. Kassem, C. Brambillasca, B. Miguel, E. Tremoli, P. Biglioli, and F. Alamanni Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis Eur. Heart J., February 1, 2009; 30(3): 297 - 304. [Abstract] [Full Text] [PDF]

				C. A. Mestres, M. A. Castro, E. Bernabeu, M. Josa, R. Cartana, J. L. Pomar, J. M. Miro, J. Mulet, and the Hospital Clinico Endocarditis Study Group Preoperative risk stratification in infective endocarditis. Does the EuroSCORE model work? Preliminary results Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 281 - 285. [Abstract] [Full Text] [PDF]