External validation of EuroSCORE II, additive EuroSCORE, and the STS predicted risk of mortality at 2,600 meters above sea level: a retrospective cohort study from a Latin American cardiac surgery centre
4 affiliations
- 1Critical and Intensive Care Medicine, Hospital Universitario Mayor-Méderi
- 2Facultad de Medicina, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario
- 3Cardiovascular Surgery, Hospital Universitario Mayor-Méderi
- 4Cardiology Department, La Cardio
Abstract
Background: EuroSCORE II, the Additive EuroSCORE, and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) are widely used cardiac surgery risk models, but their performance has not been evaluated in a cardiac surgery centre located at high altitude (≥2,500 m asl).
Methods: We conducted a retrospective external validation study using prospectively collected registry data from consecutive adult cardiac surgery procedures performed at Hospital Universitario Mayor-Méderi (2,600 m asl), Bogotá, Colombia, between January 2019 and February 2026 ( N = 1,486). EuroSCORE II and the Additive EuroSCORE were calculated from the registry with the published models and evaluated in the full cohort; STS PROM was obtained from the official STS online calculator (2018 models) for the procedures within its scope ( n = 1,076). The outcome was in-hospital mortality. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC), and calibration with the observed to expected (O/E) ratio, calibration in the large, calibration slope, and calibration plots.
Results: In-hospital mortality was 7.9% (117/1,486), and 82.3% of procedures were non-elective. The AUC was 0.736 (95% CI 0.687 to 0.785) for EuroSCORE II, 0.733 (0.684 to 0.783) for the Additive EuroSCORE, and 0.815 (0.757 to 0.873) for STS PROM. All three models underestimated mortality: the O/E ratio was 2.50 (2.09 to 3.00) for EuroSCORE II, 1.50 (1.25 to 1.79) for the Additive EuroSCORE, and 2.72 (2.14 to 3.47) for STS PROM. Calibration slopes were 1.04 (0.82 to 1.26), 1.94 (1.46 to 2.41), and 1.31 (1.01 to 1.60), respectively. Underestimation was present across procedure types, risk strata, and calendar years, and persisted in sensitivity analyses of variable mapping and missing data (EuroSCORE II O/E 2.37 to 3.05).
Conclusions: In this high-altitude Colombian centre, EuroSCORE II, the Additive EuroSCORE, and STS PROM ranked patients acceptably, STS PROM best, but all underestimated in-hospital mortality, EuroSCORE II and STS PROM by more than twofold. The study design cannot separate an effect of altitude from differences in case mix, urgency, and local care. Local recalibration is needed before these models are used for counselling or benchmarking in this setting.
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BibTeX
@article{rodriguezlima2026external,
title = {{External validation of EuroSCORE II, additive EuroSCORE, and the STS predicted risk of mortality at 2,600 meters above sea level: a retrospective cohort study from a Latin American cardiac surgery centre}},
author = {David Rene Rodríguez-Lima and Javier Darío Garzón-Rodríguez and Paula Liliana Torres-Gómez and Cristhian Rubio-Ramos and Leonardo Andrés Gómez-Cortes and Esther María Campo-Bautista and Edith Eliana Rodriguez-Aparicio and Juan Diego Toro-Egas},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1840998},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1840998/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - External validation of EuroSCORE II, additive EuroSCORE, and the STS predicted risk of mortality at 2,600 meters above sea level: a retrospective cohort study from a Latin American cardiac surgery centre
AU - David Rene Rodríguez-Lima
AU - Javier Darío Garzón-Rodríguez
AU - Paula Liliana Torres-Gómez
AU - Cristhian Rubio-Ramos
AU - Leonardo Andrés Gómez-Cortes
AU - Esther María Campo-Bautista
AU - Edith Eliana Rodriguez-Aparicio
AU - Juan Diego Toro-Egas
PY - 2026
DA - 2026/10/07
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1840998
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1840998/full
AB - Background: EuroSCORE II, the Additive EuroSCORE, and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) are widely used cardiac surgery risk models, but their performance has not been evaluated in a cardiac surgery centre located at high altitude (≥2,500 m asl). Methods: We conducted a retrospective external validation study using prospectively collected registry data from consecutive adult cardiac surgery procedures performed at Hospital Universitario Mayor-Méderi (2,600 m asl), Bogotá, Colombia, between January 2019 and February 2026 ( N = 1,486). EuroSCORE II and the Additive EuroSCORE were calculated from the registry with the published models and evaluated in the full cohort; STS PROM was obtained from the official STS online calculator (2018 models) for the procedures within its scope ( n = 1,076). The outcome was in-hospital mortality. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC), and calibration with the observed to expected (O/E) ratio, calibration in the large, calibration slope, and calibration plots. Results: In-hospital mortality was 7.9% (117/1,486), and 82.3% of procedures were non-elective. The AUC was 0.736 (95% CI 0.687 to 0.785) for EuroSCORE II, 0.733 (0.684 to 0.783) for the Additive EuroSCORE, and 0.815 (0.757 to 0.873) for STS PROM. All three models underestimated mortality: the O/E ratio was 2.50 (2.09 to 3.00) for EuroSCORE II, 1.50 (1.25 to 1.79) for the Additive EuroSCORE, and 2.72 (2.14 to 3.47) for STS PROM. Calibration slopes were 1.04 (0.82 to 1.26), 1.94 (1.46 to 2.41), and 1.31 (1.01 to 1.60), respectively. Underestimation was present across procedure types, risk strata, and calendar years, and persisted in sensitivity analyses of variable mapping and missing data (EuroSCORE II O/E 2.37 to 3.05). Conclusions: In this high-altitude Colombian centre, EuroSCORE II, the Additive EuroSCORE, and STS PROM ranked patients acceptably, STS PROM best, but all underestimated in-hospital mortality, EuroSCORE II and STS PROM by more than twofold. The study design cannot separate an effect of altitude from differences in case mix, urgency, and local care. Local recalibration is needed before these models are used for counselling or benchmarking in this setting.
SN - 2297-055X
ER -