Abstract
Mediastinitis is a severe complication of major heart surgery (MHS). Scoring systems constitute a very useful tool for risk assessment and to establish appropriate prevention strategies.
Highlights
Mediastinitis is a severe complication of major heart surgery (MHS)
The discriminatory power was evaluated by area under the receiver operating characteristic curves (AUC-ROC)
The predictive model based on 7 factors showed excellent predictive power
Summary
Data of 4526 patients admitted after MHS to our Cardiovascular ICU (January 2005,-June 2011) were prospectively collected. After exclusion of 655 patients, 3970 were analyzed to identify risk factors for mediastinitis. A model was generated by logistic regression analysis in a subgroup of 2618 randomly selected patients and validated in a second cohort of 1352. The discriminatory power was evaluated by area under the receiver operating characteristic curves (AUC-ROC). The mediastinitisscore (“MED-Score”) was created using the points estimate for each variable, with beta coefficients of the final model. For stratification three risk levels were generated. We assessed the ability of “MED-Score, Euroscore (ES), and the Society of Thoracic Surgeons score (STS) to predict mediastinitis using ROC curves comparison (MannWhitney). Concordance of risk stratification by scoring systems was evaluated using weighted Kappa index.
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