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A first postoperative day predictive score of mortality for cardiac surgery.

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 PaO(2)/FiO(2) <100 (9.47); epinephrine or norepinephrine dose >/=0.1 microg/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.