cliot (version 1.0.0)

euroscore_ii: European System for Cardiac Operative Risk Evaluation (EuroSCORE) II

Description

Calculates the EuroSCORE II, which predicts in-hospital mortality after major cardiac surgery. This model improves upon the original EuroSCORE by incorporating a contemporary patient population and using a full logistic regression model, allowing for a more accurate and nuanced risk prediction.

Usage

euroscore_ii(age, gender, renal_impairment, extracardiac_arteriopathy, poor_mobility,
             previous_cardiac_surgery, chronic_lung_disease, active_endocarditis,
             critical_preoperative_state, diabetes_on_insulin, nyha_class,
             ccs_class_4_angina, lv_function, recent_mi, pulmonary_hypertension,
             urgency, weight_of_intervention, surgery_on_thoracic_aorta)

Value

A list containing the predicted in-hospital mortality risk as a percentage.

Arguments

age

Numeric. Patient age in years.

gender

Character. "male" or "female".

renal_impairment

Character. Degree of renal impairment, categorized by Creatinine Clearance (CrCl) or Dialysis status. Options: "normal" (CrCl > 85 mL/min), "creatinine_clearance_50_85" (50-85 mL/min), "creatinine_clearance_lt_50" (< 50 mL/min), or "dialysis".

extracardiac_arteriopathy

Numeric (0 or 1). Includes claudication, carotid occlusion >50%, or previous/planned intervention on peripheral arteries or aorta.

poor_mobility

Numeric (0 or 1). Severe impairment of mobility due to musculoskeletal or neurological dysfunction.

previous_cardiac_surgery

Numeric (0 or 1). History of previous major cardiac operation involving opening of the pericardium.

chronic_lung_disease

Numeric (0 or 1). Long-term use of bronchodilators or steroids for lung disease.

active_endocarditis

Numeric (0 or 1). Patient is still on antibiotic treatment for endocarditis at the time of surgery.

critical_preoperative_state

Numeric (0 or 1). Presence of critical signs (e.g., VT/VF, cardiac massage, pre-op ventilation, inotropes, IABP/VAD before OR, acute renal failure/anuria).

diabetes_on_insulin

Numeric (0 or 1). Diabetes mellitus treated with insulin.

nyha_class

Numeric (1, 2, 3, or 4). New York Heart Association functional class.

ccs_class_4_angina

Numeric (0 or 1). Angina at rest (Canadian Cardiovascular Society Class 4 Angina).

lv_function

Character. Left Ventricular Ejection Fraction (LVEF). Options: "good" (> 50%), "moderate" (31-50%), "poor" (21-30%), or "very_poor" (<= 20%).

recent_mi

Numeric (0 or 1). Myocardial infarction within the last 90 days.

pulmonary_hypertension

Character. Systolic Pulmonary Artery Pressure (PAP). Options: "none" (< 31 mmHg), "moderate" (31-55 mmHg), or "severe" (> 55 mmHg).

urgency

Character. Urgency of the procedure. Options: "elective", "urgent", "emergency", or "salvage" (most critical).

weight_of_intervention

Character. The type of procedure. Options: "isolated_cabg", "single_non_cabg", "two_procedures" (e.g., CABG + valve), or "three_procedures".

surgery_on_thoracic_aorta

Numeric (0 or 1). Surgery on the thoracic aorta (including root and arch).

Details

The EuroSCORE II is calculated using a logistic regression model: $$Predicted Mortality = \frac{e^L}{1 + e^L}$$ Where \(L\) is the linear predictor (\(\beta_0 + \sum \beta_i X_i\)) derived from the 18 patient-related risk factors and surgical factors.

References

Nashef SAM, Roques F, Sharples PE, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-744. doi:10.1093/ejcts/ezs043

Examples

euroscore_ii(
  age = 65,
  gender = "male",
  renal_impairment = "normal",
  extracardiac_arteriopathy = 0,
  poor_mobility = 0,
  previous_cardiac_surgery = 0,
  chronic_lung_disease = 0,
  active_endocarditis = 0,
  critical_preoperative_state = 0,
  diabetes_on_insulin = 0,
  nyha_class = 1,
  ccs_class_4_angina = 0,
  lv_function = "good",
  recent_mi = 0,
  pulmonary_hypertension = "none",
  urgency = "elective",
  weight_of_intervention = "isolated_cabg",
  surgery_on_thoracic_aorta = 0
)