European System for Cardiac Operative Risk Evaluation (EuroSCORE) II

Predicts in-hospital mortality risk post major cardiac surgery.

Refer to the text below the calculator for more information about the score, its variables and predictive value.


The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of 2012 is a cardiac risk model for predicting mortality after cardiac surgery and is the second version of the original score published in 1995.

The renewed version was tested in response to published evidence that the original model overpredicted risk as the results of cardiac surgery have substantially improved with a sustained reduction of risk-adjusted mortality so the EuroSCORE II maintains and optimizes the original score in the contemporary cardiac surgical practice.


Each of the 18 variables (and in some cases, their different answer options) of the score is multiplied by a coefficient, the sum of the resultant multiplications being used in the following:

Predicted mortality = ey / (1 + ey)

Where y = -5.324537 + ∑ βixi

and βi is coefficient and xi is variable.


Patient Factors

Patient Age
Patient Gender
Insulin-dependent diabetes mellitus
Chronic pulmonary dysfunction
Neurological or musculoskeletal dysfunction severely affecting mobility
Critical preop state*
* ≥1 of the following in the same hospital admission as the operation: ventricular tachycardia or fibrillation or aborted sudden death; cardiac massage; ventilation before arrival to OR; inotropes; IABP or VAD before arrival to OR; acute renal failure, defined as anuria or oliguria <10 mL/hr

Cardiac-Specific Factors

NYHA class (New York Heart Association Functional Classification for Heart Failure)
Canadian Cardiovascular Society (CCS) Angina class 4*
* Inability to perform any activity without angina or angina at rest
Extracardiac arteriopathy*
* ≥1 of the following: claudication; carotid occlusion or >50% stenosis (NASCET criteria); amputation for arterial disease; previous or planned intervention on abdominal aorta, limb arteries, or carotids
Previous cardiac surgery*
* ≥1 previous major cardiac operation involving opening the pericardium
Active endocarditis*
* i.e., on antibiotics for endocarditis at time of surgery
Left ventricular function or left ventricular ejection fraction
Recent MI (≤90 days before operation)
Pulmonary artery systolic pressure

Procedural Factors

Urgency*
* Elective: routine admission for operation | Urgent: not electively admitted for operation but require surgery on current admission for medical reasons and cannot be discharged without definitive procedure | Emergency: operation before the beginning of the next working day after the decision to operate | Salvage: patients requiring CPR (external) en route to the OR or before induction of anesthesia (excludes CPR after induction of anesthesia)
Weight of procedure*
* i.e., extent of intervention: Isolated CABG | Isolated non-CABG major procedure (e.g. single valve procedure, replacement of ascending aorta, correction of septal defect, etc) | 2 major procedures (e.g. CABG and AVR), or CABG and mitral valve repair (MVR), or AVR and replacement of ascending aorta, or CABG and maze procedure, or AVR and MVR, etc | ≥3 major procedures (e.g. AVR, MVR, and CABG, or MVR, CABG, and tricuspid annuloplasty, etc), or aortic root replacement when it includes AVR or repair, coronary reimplantation, and root and ascending replacement
Thoracic aorta surgery
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EuroSCORE II - variables and coefficients

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of 2012 is a cardiac risk model for predicting mortality after cardiac surgery and is the second version of the original score published in 1995, with the aim to bring the score up to date with current evolution of the cardiac surgery field, i.e. to improve the original score’s prediction in line with the sustained reduction of risk-adjusted mortality of improved cardiac surgery results.

According to the 2012 study, review of the literature and of feedback received from users identified several improvement areas, to name some:

  • Creatinine clearance (CC) is a better predictor than absolute serum creatinine.
  • Hepatic function is not represented in the original score.
  • The model is not sufficiently sensitive to the ‘weight’ of the cardiac intervention.

In consequence the initial variables were modified or complemented with new risk factors, to form the EuroSCORE II:

Patient Factors
Description Coefficient
Age 1 multiplied by coefficient if age ≤60, then +1 for each year above 60 (i.e. 65 years = 6 multiplied by coefficient) 0.0285181
Gender Female 0.2196434
Insulin-dependent diabetes mellitus Yes 0.3542749
Chronic pulmonary dysfunction Yes 0.1886564
Neurological or musculoskeletal dysfunction severely affecting mobility Yes 0.2407181
Renal dysfunction (Creatinine clearance by Cockcroft-Gault formula) CC >85 mL/min 0
CC 51-85 mL/min 0.303553
CC ≤50 mL/min 0.8592256
On dialysis (regardless of serum creatinine) 0.6421508
Critical preop state
≥1 of the following in the same hospital admission as the operation: ventricular tachycardia or fibrillation or aborted sudden death; cardiac massage; ventilation before arrival to OR; inotropes; IABP or VAD before arrival to OR; acute renal failure, defined as anuria or oliguria <10 mL/hr
Yes 1.086517
Cardiac-Specific Factors Description Coefficient
NYHA class (New York Heart Association Functional Classification for Heart Failure) Class I: no symptoms on moderate exertion 0
Class II: symptoms on moderate exertion 0.1070545
Class III: symptoms on light exertion 0.2958358
Class IV: symptoms at rest 0.5597929
Canadian Cardiovascular Society (CCS) Angina class 4
Inability to perform any activity without angina or angina at rest
Yes 0.2226147
Extracardiac arteriopathy
≥1 of the following: claudication; carotid occlusion or >50% stenosis (NASCET criteria); amputation for arterial disease; previous or planned intervention on abdominal aorta, limb arteries, or carotids
Yes 0.5360268
Previous cardiac surgery
≥1 previous major cardiac operation involving opening the pericardium
Yes 1.118599
Active endocarditis
i.e., on antibiotics for endocarditis at time of surgery
Yes 0.6194522
Left ventricular function or left ventricular ejection fraction Good (LVEF ≥51%) 0
Moderate (LVEF 31-50%) 0.3150652
Poor (LVEF 21-30%) 0.8084096
Very poor (LVEF ≤20%) 0.9346919
Recent MI
≤90 days before operation
Yes 0.1528943
Pulmonary artery systolic pressure <31 mmHg 0
31-54 mmHg 0.1788899
≥55 mmHg 0.3491475
Procedural Factors
Description Coefficient
Urgency Elective: routine admission for operation 0
Urgent: not electively admitted for operation but require surgery on current admission for medical reasons and cannot be discharged without definitive procedure 0.3174673
Emergency: operation before the beginning of the next working day after the decision to operate 0.7039121
Salvage: patients requiring CPR (external) en route to the OR or before induction of anesthesia (excludes CPR after induction of anesthesia) 1.362947
Weight of procedure
i.e., extent of intervention
Isolated CABG 0
Isolated non-CABG major procedure (e.g. single valve procedure, replacement of ascending aorta, correction of septal defect, etc) 0.0062118
2 major procedures (e.g. CABG and AVR), or CABG and mitral valve repair (MVR), or AVR and replacement of ascending aorta, or CABG and maze procedure, or AVR and MVR, etc 0.5521478
≥3 major procedures (e.g. AVR, MVR, and CABG, or MVR, CABG, and tricuspid annuloplasty, etc), or aortic root replacement when it includes AVR or repair, coronary reimplantation, and root and ascending replacement 0.9724533
Thoracic aorta surgery Yes 0.6527205

Each of the 18 variables (and in some cases, their different answer options) of the score is multiplied by a coefficient, the sum of the resultant multiplications being used in the following:

Predicted mortality = ey / (1 + ey)

Where y = -5.324537 + ∑ βixi

and βi is coefficient and xi is variable

As the EuroSCORE II was constructed from an international, contemporaneous and highly accurate, validated database, thus offering reassurance that it is a robust risk model that can be used for predicting cardiac surgery in-hospital mortality in settings across the world.

It is important to note however that limitations to the score are dictated by the restrictions imposed by the methodology and logistics of constructing the score.

 

References

Original reference

Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-44.

Validation

Chalmers J, Pullan M, Fabri B, et al. Validation of EuroSCORE II in a modern cohort of patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2013;43(4):688-94.

Kalender M, Adademir T, Tasar M, et al. Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients. Kardiochir Torakochirurgia Pol. 2014;11(3):252-6.


Specialty: Cardiology

System: Cardiovascular

Objective: Risk screening

No. Of Variables: 18

Year Of Study: 2012

Abbreviation: EUROSCORE II

Article By: Denise Nedea

Published On: May 14, 2020

Last Checked: May 14, 2020

Next Review: May 14, 2025