The SOFA score demonstrated the highest discrimination for predicting major postoperative complications after cardiac surgery (AUC 0.881; 95% CI 0.819-0.928), outperforming preoperative risk scores.
Observational (n=195)
Do early postoperative ICU severity scores predict major postoperative complications and mortality better than preoperative risk scores in patients undergoing cardiac surgery?
Early postoperative ICU severity scores, particularly SOFA and APACHE II, outperform the preoperative EuroSCORE II in predicting major complications and in-hospital mortality after cardiac surgery.
Effect estimate: AUC 0.881 (95% CI 0.819-0.928)
Background: Early identification of patients at risk for adverse outcomes after cardiac surgery remains a major clinical challenge. While preoperative risk scores are widely used, the prognostic value of early postoperative ICU severity scores and functional performance measures has not been fully clarified. Methods: This prospective observational study included 195 patients undergoing cardiac surgery between 2018 and 2024. Predictive performance of EuroSCORE II, the SOFA score, the APACHE II score, Karnofsky performance status, handgrip strength, and phase angle was assessed for postoperative complications and mortality. Receiver operating characteristic (ROC) curves with 95% confidence intervals were calculated, and pairwise comparisons between ROC curves were performed. Major postoperative complications were analyzed using a composite endpoint including stroke, prolonged intubation, sepsis, and reoperation, excluding systemic inflammatory response syndrome (SIRS). Results: Major postoperative complications occurred in 46 patients (23.6%). For prediction of major postoperative complications, SOFA demonstrated the highest discrimination (AUC = 0.881, 95% CI 0.819–0.928), followed by APACHE II (AUC = 0.826, 95% CI 0.753–0.888) and EuroSCORE II (AUC = 0.695, 95% CI 0.602–0.785). In-hospital mortality occurred in 19 patients (9.7%). SOFA showed the strongest predictive performance (AUC = 0.915, 95% CI 0.851–0.968), followed by APACHE II (AUC = 0.869, 95% CI 0.781–0.939) and EuroSCORE II (AUC = 0.742, 95% CI 0.595–0.870). During follow-up, 54 patients (27.7%) died. Predictive performance was comparable between SOFA (AUC = 0.710, 95% CI 0.618–0.793), APACHE II (AUC = 0.695, 95% CI 0.606–0.782), and EuroSCORE II (AUC = 0.680, 95% CI 0.599–0.757). Conclusions: Early postoperative ICU severity scores, particularly SOFA and APACHE II, demonstrated strong predictive ability for major postoperative complications and in-hospital mortality following cardiac surgery and outperformed preoperative risk scores.
Liatsos et al. (2026) conducted an observational in Cardiac surgery (n=195). Early postoperative ICU severity scores (SOFA, APACHE II) vs. Preoperative risk scores (EuroSCORE II) was evaluated on Major postoperative complications (AUC 0.881, 95% CI 0.819-0.928). The SOFA score demonstrated the highest discrimination for predicting major postoperative complications after cardiac surgery (AUC 0.881; 95% CI 0.819-0.928), outperforming preoperative risk scores.