Does Parsonnet scoring model predict mortality following adult cardiac surgery in India.
Loading...
Date
2015-04
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac
surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult
cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was
determined for each patient and its predictive ability for in‑hospital mortality was evaluated. The validation of
Parsonnet score was performed for the total data and separately for the sub‑groups coronary artery bypass
grafting (CABG), valve surgery and combined procedures (CABG with valve surgery). The model calibration
was performed using Hosmer–Lemeshow goodness of fit test and receiver operating characteristics (ROC)
analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the
Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients),
7.1% (34 patients) for CABG, 4.3% (16 patients) for valve surgery and 16.2% (6 patients) for combined
procedures. The Hosmer–Lemeshow statistic was <0.05 for the total data and also within the sub‑groups
suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The
area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62–0.77) and when tested
separately, it was 0.73 (0.64–0.81) for CABG, 0.79 (0.63–0.92) for valve surgery (good discriminatory ability)
and only 0.55 (0.26–0.83) for combined procedures. The independent predictors of mortality determined for the
total data were low ejection fraction (odds ratio [OR] ‑ 1.7), preoperative intra‑aortic balloon pump (OR ‑ 10.7),
combined procedures (OR ‑ 5.1), dialysis dependency (OR ‑ 23.4), and re‑operation (OR ‑ 9.4).
Conclusions: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive
value for the total data and for CABG and poor predictive value for combined procedures
Description
Keywords
Cardiac surgery, heart disease, mortality, postoperative complications, risk stratification in cardiac surgery
Citation
Srilata Moningi, Padhy Narmada, Padmaja Durga, Gopinath Ramachandran. Does Parsonnet scoring model predict mortality following adult cardiac surgery in India. Annals of Cardiac Anaesthesia. 2015 Apr; 18(2): 161-169.