Related Experiment Video
Updated: Apr 28, 2026
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Prospective external validation of a predictive score for postoperative pulmonary complications
Valentín Mazo1, Sergi Sabaté, Jaume Canet
1From the Department of Anesthesiology (V.M.) and Department of Anesthesiology and Postoperative Care Unit (J.C.), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Anesthesiology, Fundació, Puigvert, Barcelona, Spain (S.S.); Department of Anesthesiology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain (L.G.); Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (M.G.d.A.); Department of Anesthesia and Critical Care, Hospital Clínico Universitario, University of Valencia, Valencia, Spain (J.B.); Department of Anesthesiology and Critical Care, Université Pierre et Marie Curie-Paris VI, CHU Pitié-Salpêtrière, Paris, France (O.L.); Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany (A.H.); and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital-IST, University of Genoa, Genoa, Italy (P.P.).
The Assess Respiratory Risk in Surgical Patients in Catalonia score effectively predicts postoperative pulmonary complications (PPCs) in European hospitals. However, its performance varies across different geographic regions, highlighting the need for localized validation.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Thoracic Surgery
Background:
- No universally validated risk score for postoperative pulmonary complications (PPCs) exists.
- The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was developed to predict PPCs.
- This study aimed to test the generalizability of the ARISCAT score in a large European cohort.
Purpose of the Study:
- To evaluate the external validity and generalizability of the ARISCAT score for predicting PPCs.
- To assess the score's performance across different European geographic regions.
- To determine the accuracy of the ARISCAT score in a diverse surgical patient population.
Main Methods:
- A prospective cohort study involving 5,859 surgical patients across 63 European centers.
- Data collected included ARISCAT risk factors and PPC occurrence.
- Statistical analysis involved calculating discrimination, calibration, and diagnostic accuracy measures for the ARISCAT score.
Main Results:
- The ARISCAT score demonstrated good discrimination (c-statistic: 0.80) in the overall cohort of 5,099 patients, with an observed PPC rate of 7.9%.
- The score accurately predicted risk levels, with a positive likelihood ratio of 7.12 for high-risk scores (≥45).
- Performance varied geographically, with the best results in Western Europe (c-statistic: 0.87) and the poorest in Eastern Europe.
Conclusions:
- The ARISCAT score can predict three levels of PPC risk in clinical settings beyond its development location.
- Geographic variations in performance necessitate careful consideration when applying the ARISCAT score.
- Further validation in diverse populations is recommended to optimize PPC risk prediction.
