A First Postoperative Day Predictive Score of Mortality for Cardiac Surgery

Original
Article

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,PhD^2,3

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.