The value of the ACEF II score in Chinese patients with elective and non-elective cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Medical Informatics

Background:

• Cardiac surgery outcomes require accurate risk stratification.
• The existing ACEF score has limitations in predicting postoperative complications.
• The ACEF II score is a newer model proposed for improved risk assessment.

Purpose of the Study:

• To evaluate the predictive performance of the ACEF II score for in-hospital mortality and acute kidney injury requiring dialysis (AKI-D).
• To compare the ACEF II score with the original ACEF score in Chinese adult patients undergoing cardiopulmonary bypass open heart surgery.
• To assess the score's utility in both elective and non-elective surgical settings.

Main Methods:

• Retrospective analysis of 9748 adult patients undergoing open heart surgery between 2010-2015.
• Utilized Hosmer-Lemeshow goodness of fit test for calibration and ROC curve analysis for discrimination.
• Evaluated ACEF II and ACEF scores for predicting in-hospital death and AKI-D in elective and non-elective subgroups.

Main Results:

• The ACEF II score demonstrated moderate discrimination for in-hospital death in elective (AUC=0.704) and non-elective (AUC=0.725) surgery.
• ACEF II showed superior prediction for in-hospital death in non-elective surgery compared to ACEF (AUC=0.625).
• For AKI-D, ACEF II (AUC=0.718) outperformed ACEF (AUC=0.626), but both had poor discrimination in non-elective cases.

Conclusions:

• The ACEF II score is comparable to the ACEF score for predicting in-hospital death in elective cardiac surgery.
• ACEF II offers improved prediction of in-hospital death in non-elective cardiac surgery.
• The ACEF II score is a potentially useful tool for assessing AKI-D risk in Chinese adults undergoing elective cardiac surgery.