EuroSCORE II

Overview

EuroSCORE II replaced the original additive and logistic EuroSCORE (1999) as the recommended preoperative risk model for adult cardiac surgery in Europe. It uses a fully logistic regression model, yielding a predicted 30-day in-hospital mortality as a probability rather than a risk category. The model was derived from 22,381 consecutive patients undergoing cardiac surgery in 43 countries between May 2010 and July 2011.

Formula

logit = −5.324537 + Σ (variable coefficients)

Predicted mortality = e^logit / (1 + e^logit)

Patient Factors

Variable	Coefficient (β)
Age (per year above 60)	0.0285181
Female sex	0.2196434
Serum creatinine > 200 µmol/L or dialysis	0.6521653
Extracardiac arteriopathy	0.5360268
Poor mobility	0.2407949
Previous cardiac surgery	1.118837
COPD (long-term bronchodilator/steroid use)	0.1886564
Active endocarditis	0.6194522
Critical preoperative state	1.086517
Insulin-dependent diabetes mellitus	0.3542749

Cardiac & Operation Factors

Variable	Category	Coefficient (β)
NYHA class	II	0.1082900
	III	0.2962689
	IV	0.5462446
CCS angina class 4	Yes	0.2226147
LV function (EF)	Moderate 31–50 %	0.3150652
	Poor 21–30 %	0.8084096
	Very poor ≤ 20 %	0.9346919
Recent MI (≤ 90 days)	Yes	0.1528943
Pulmonary hypertension	Moderate 31–55 mmHg	0.1788899
	Severe > 55 mmHg	0.3491475
Urgency	Urgent	0.3174673
	Emergency	0.7039121
	Salvage	1.3337492
Weight of procedure	Two procedures	0.5521478
	Three or more	0.9724533
Surgery on thoracic aorta	Yes	0.6527205
Post-infarct septal rupture	Yes	1.462009

Risk Classification

Predicted Mortality	Risk Class
< 2 %	Low
2–5 %	Moderate
5–10 %	High
> 10 %	Very high

Interpretation Note

Contemporary single-centre and registry studies have demonstrated that EuroSCORE II may overestimate mortality in high-risk cohorts as outcomes have improved since 2010–2011 derivation. The score should be used as one component of a comprehensive preoperative assessment and discussed in a multidisciplinary Heart Team context.

Literature

Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734–745.

Kirmani BH, Mazhar K, Fabri BM, Pullan DM. Comparison of the EuroSCORE II and Society of Thoracic Surgeons 2008 risk tools. Eur J Cardiothorac Surg. 2013;44(6):999–1005.