Original
Article
A First Postoperative Day Predictive Score of Mortality for Cardiac Surgery

Renato Vieira Gomes, MD,1,2 Bernardo Tura, MD,2 Hugo Tannus Furtado de Mendonça Filho, MD,PhD,1 Luis Antonio de Almeida Campos, MD,1,2 Alexandre Rouge, MD,1,2 Pedro Miguel de Matos Nogueira, MD,1 Marco Aurélio de Oliveira Fernandes, MD,1 Hans Fernando da Rocha Dohmann, MD,1 and Ademir Batista Cunha, MD,PhD2,3

Purpose: Several prognostic scores for cardiac surgery based on preoperative variables are available. We propose a new one based on pre-and intraoperative and first postoperative day variables for cardiac surgery patients admitted to a surgical intensive care unit.
Materials and Methods: Classical cohort of data consecutively collected from June 2000 to March 2003 (1,458 patients). Forty-six risk variables were identified. The statistical study comprised univariate analysis followed by logistic regression with receiver operating characteristics (ROC) curve.
Results: After logistic regression, the selected variables and respective odds ratios were: age >65 and <75 years (2.05); age ≥75 years (4.79); left atrial diameter >45 mm (2.58); preoperative creatinine >2 mg/dL (4.84); and cardiopulmonary bypass time ≥180 min (4.93±2). The first postoperative day variables were as follows: the worst PaO2/FiO2 <100 (9.47); epinephrine or norepinephrine dose ≥0.1 µg/kg/min (6.78); and mechanical ventilation time >12 h (2.24). The area under the ROC curve was 0.84.
Conclusion: The score shows the strength of first postoperative day variables, probably related to intraoperative conditions. It also evidences the importance of left atrial diameter as a new marker of preoperative risk. (Ann Thorac Cardiovasc Surg 2007; 13: 159-164)

Key words: cardiac surgery, prognosis, postoperative period, death

1Surgical Intensive Care Unit, Hospital Pró-Cardíaco, 2Surgical Intensive Care Unit, Instituto Nacional de Cardiologia Laranjeiras, and 3Department of Cardiology, Hospital Antônio Pedro of the Fluminense Federal University, Rio de Janeiro, Brazil

Received June 27, 2006; accepted for publication September 11, 2006.
Address reprint requests to Renato Vieira Gomes, MD: Surgical Intensive Care Unit MSc. Hospital Pró-Cardíaco, Rua General Polidoro 192, Botafogo, Rio de Janeiro, RJ, ZIP: 22280-000, Brazil.

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