RT info:eu-repo/semantics/article
T1 Development of the Post Cardiac Surgery (POCAS) prognostic score
A1 Tamayo Gómez, Eduardo
A1 Fierro Lorenzo, María Inmaculada
A1 Bustamante Munguira, Juan
A1 Heredia Rodríguez, María
A1 Jorge Monjas, Pablo
A1 Maroto, Laura
A1 Gómez Sánchez, Esther
A1 Bermejo Martín, Jesús Francisco
A1 Álvarez González, Francisco Javier
A1 Gómez Herreras, José Ignacio
K1 3213.07 Cirugía del Corazón
AB The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score. Methods: We conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series. Results: In-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score). Conclusions: Our new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation.
PB Springer Nature
SN 1364-8535
YR 2013
FD 2013
LK http://uvadoc.uva.es/handle/10324/45590
UL http://uvadoc.uva.es/handle/10324/45590
LA eng
NO Critical Care, 2013, vol. 17. 10 p.
NO Producción Científica
DS UVaDOC
RD 11-jul-2024