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.
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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 · 12:00 AM
Last Checked: May 14, 2020
Next Review: May 14, 2025