Post Cardiac Surgery (POCAS) Prognostic Score of Tamayo et al

Description

Tamayo et al reported the Post Cardiac Surgery (POCAS) prognostic score for predicting operative mortality for a patient undergoing cardiac surgery. The authors are from the Hospital Universitario de La Princesa in Madrid.

Patient selection: cardiac surgery with cardiopulmonary bypass

Rate on in-hospital mortality: 9%

Outcome: 90-day in-hospital mortality

Parameters at admission to ICU after surgery:

(1) mean arterial pressure (MAP), within 30 minutes of ICU admission and when patient hemodynamically stable

(2) serum bicarbonate in mmol/L (mEq/L)

(3) serum lactate ratio in mmol/L

(4) INR

Parameter	Finding	Points
lactate	< 16 mmol/L	3
	16 to 24.9	4
	25 to 34.9	6
	35 to 52.9	9
	53 to 79	14
	> 79 mmol/L	21
mean arterial pressure	> 75 mm Hg	35
	69 to 75	41
	61 to 68	46
	60	50
	45 to 59	58
	< 45 mm Hg	75
INR	< 1.31	12
	1.31 to 1.52	14
	1.53 to 1.94	16
	1.95 to 2.65	20
	> 2.65	30
bicarbonate	> 27.4 mmol/L	14
	25.7 to 27.4	1511
	24.1 to 25.6	16
	22.8 to 24	17
	20.4 to 22.7	18
	14.6 to 20.3	22
	< 14.6 mmol/L	35

total score =

= SUM(points for all 4 parameters)

Interpretation:

• minimum score: 64

• maximum score: 161

• The higher the score the greater the risk of mortality.

If risk categories are combined, the following groups are identified.

Total Score	Risk Group	90-Day In-Hospital Mortality
64 to 90	low	2.3%
91 to 105	medium	16%
106 to 128	high	56%
> 128	very high	95%

If the low and medium risk groups are not combined, the following rates are seen.

Total Score	Mortality
64 to 74	0.4%
75 to 81	1.5%
82 to 90	6%
91 to 100	11%
101 to 105	28%

value of X =

= (0.113 * (score)) - 12.671

probability of in-hospital mortality =

= 1/(1+EXP((-1) * X))

Performance:

• The area under the ROC curve is 0.90.

• The mean arterial pressure had an AROC of 0.86.

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Post Cardiac Surgery (POCAS) Prognostic Score of Tamayo et al

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