• Themistocles Exarchopoulos, Efstratia Charitidou, Panagiotis Dedeilias, Christos Charitos, and Christina Routsi.
• Themistocles Exarchopoulos is a critical care nurse at Mitera Hospital, Marousi, Greece. Efstratia Charitidou is a statistician and PhD student at the National Technical University of Athens, Athens, Greece. Panagiotis Dedeilias and Christos Charitos are cardiac surgeons at Evangelismos Hospital, Athens, Greece. Christina Routsi is an associate professor at the Medical School of the University of Athens, Athens, Greece. th.exarcho@gmail.com.
• Am. J. Crit. Care. 2015 Jul 1;24(4):327-34; quiz 335.

BackgroundMost scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients.ObjectivesTo compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery.MethodsConsecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity.ResultsA total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU).ConclusionsCASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients.©2015 American Association of Critical-Care Nurses.

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