Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

• Published in: Arquivos brasileiros de cardiologia 2020-09, Vol.115 (3), p.452-459
• Main Authors: Franzotti, Silvana Alves Dos Santos, Sloboda, Dyenily Alessi, Silva, Juliana Rosendo, Souza, Ellian Amorim Santos, Reboreda, Jessica Zamora, Ferretti-Rebustini, Renata Eloah de Lucena, Nogueira, Lilia de Souza
• Format: Article
• Language: English
• Subjects: Brazil; Cross-Sectional Studies; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Myocardial Revascularization; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Retrospective Studies; ROC Curve
• ISSN: 1678-4170
• DOI: 10.36660/abc.20190120

Patients in the postoperative period of myocardial revascularization (Coronary Artery Bypass Grafting - CABG) surgery admitted to the intensive care unit (ICU) are at risk of complications which increase the length of stay and morbidity and mortality. Therefore, early recognition of these risks is essential to optimize prevention strategies and a satisfactory clinical outcome. To analyze the performance of severity indices in predicting complications in patients in the postoperative of CABG during the ICU stay. A cross-sectional study with retrospective analysis of electronic medical records of patients aged ≥ 18 years who underwent isolated CABG and were admitted to the ICU of a cardiology hospital in São Paulo, Brazil. The areas under the receiver operating characteristic curves (AUC) with a 95% confidence interval were analyzed to verify the accuracy of the European System for Cardiac Operative Risk Evaluation (EuroScore), Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) indices in predicting complications. The sample consisted of 366 patients (64.58 ± 9.42 years; 75.96% male). The complications identified were: respiratory (24.32%), cardiovascular (19.95%), neurological (10.38%), hematological (10.38%), infectious (6.56%) and renal (3.55%). APACHE II showed satisfactory performance for predicting neurological (AUC 0.72) and renal (AUC 0.78) complications. APACHE II excelled in predicting neurological and renal complications. None of the indices performed well in predicting the other analyzed complications. Therefore, severity indices should not be used indiscriminately in order to predict all complications frequently presented by patients after CABG. (Arq Bras Cardiol. 2020; 115(3):452-459).