European Heart Journal (2003) 24, 1–2

Letter to the Editor
doi:10.1016/S0195-668X(02)00799-6

The logistic EuroSCORE
Dear Sir,The European System for Cardiac
Operative Risk Evaluation (EuroSCORE) identifies a number of risk
factors which help to predict mortality from cardiac surgery.1 The predicted mortality (in percent) is calculated by adding the weights assigned
to each factor. Since its initial publication in 1999, EuroSCORE has been
widely used in Europe and elsewhere
and has been the subject of severalstudies. Most of these studies compared the predictive ability of theEuroSCORE to previously describedsystems2,3 or to locally derived
models.4 One original work used it asa tool in order to assess the intrainstitutional benefit in switchingfrom conventional surgery under cardiopulmonary bypass to the off-pumpapproach in coronary surgery.5 In
general, EuroSCORE was found to bean easy tool for inter-institutional
comparison with good or excellent
predictive ability. Nevertheless,many observers noted a trend to anunderestimation of the operative risk
in very high-risk patients, and it has
been suggested that full statisticalcomparison to other systems might bedifficult since comprehensive information on the logistic regression
equation of the score was neverpublished.
EuroSCORE was initially designed
to be a user-friendly system, in thehope of encouraging as many units as
possible to embark on programmes ofrisk-adjusted quality monitoring. In
this setting, although derived from alogistic regression methodology, only
the simple additive version of thescore was originally published. Thisscore could be easily calculated at
the bedside4,5 and could therefore be* Corresponding author. Tel.: +44-1480364299; fax: 44-1480-364744
E-mail address: sam.nashef@euroscore.
org (S. Nashef)

Table 1

Logistic regression model of EuroSCORE in the 1995 pilot study

Variables CoefficientAge (continuous)
FemaleSerum creatinine >200 µmol/l
Extracardiac arteriopathy
Pulmonary disease
Neurological dysfunction
Previous cardiac surgery
Recent myocardial infarct
LVEF 30–50%
LVEF <30%
Systolic pulmonary pressure >60 mmHg
Active endocarditis
Unstable angina
Emergency operation
Critical preoperative state
Ventricular septal rupture
Other than isolated coronary surgery
Thoracic aortic surgery
Constant 00.0666354
0.3304052
0.6521653
0.6558917
0.4931341
0.841626
1.002625
0.5460218
0.4191643
1.094443
0.7676924
1.101265
0.5677075
0.7127953
0.9058132
1.462009
0.5420364
1.159787−4.789594

LVEF, left ventricular ejection fraction; full definition of these variables are
published1 and can be seen on-line (http://www.euroscore.org).

used widely in Europe even in hospitals with little information technology. Today, European cardiologists and cardiac surgeons aredemonstrating a growing interest inquality control and have access toever better information technology
resources. Some may therefore wish
to use a more sophisticated risk
model than the simple additive EuroSCORE. For this reason, we seek tomake public the full details of theEuroSCORE logistic regression equation (Table 1). Using the same risk
factors, the logistic regression
version of the score (the ‘logisticEuroSCORE’) can be calculated. For agiven patient, the logistic EuroSCORE
which is the predicted mortality
according to the logistic regression
equation, can be achieved with thefollowing formula:predicted mortality⫽e(0⫹∑i Xi)
1⫹e(0⫹∑i Xi)

where 0 is the constant of the logistic regression equation (see Table 1)and i is the coefficient of the variable Xi in the logistic regression equation provided in Table 1. Xi=1 if acategorical risk factor is present and0 if it is absent. For age, Xi=1 ifpatient age <60; Xi increases by one
point per year thereafter (ie: age 59
or less Xi=1; age 60 Xi=2; age 61 Xi=3
and so on).
Cardiologists and cardiac surgeons
will be relieved to note that they do
not have to face this complex calculation with every patient; a risk calculator (additive and logistic) can beused or downloaded easily from theEuroSCORE website (http://www.
euroscore.org).
The additive EuroSCORE is simple,
well validated, user-friendly andworks at the bedside without specialised equipment. Because of its additive properties, it will tend tounderestimate risk in some very highrisk groups. The logistic EuroSCORE is
more suitable for individual risk prediction in very high risk patients andwill facilitate further sophisticatedstudy into the field of risk. Within
Europe and elsewhere in the world
there are hospitals with rudimentary,
if any, data collection and others,
where data are abundant and thestudy of risk is a specialised area ofadvanced investigation. It can therefore be argued that there is currently
a place for both simple as well as

0195-668X/03/$ - see front matter © 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

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sophisticated risk tools in this rapidly
evolving field.

References
1. Nashef SAM, Roques F, Michel P et al.
European system for cardiac operativerisk evaluation (EuroSCORE). Eur J
Cardiothorac Surg 1999;16(1):9–13.
2. Geissler HJ, Holzl P, Marohl S et al.
Risk stratification in heart surgery:comparison of six score systems. Eur J
Cardiothorac Surg 2000;17(4): 400–6.
3. Kawachi Y, Nakashima A, Toshima Yet al. Risk stratification analysis ofoperative mortality in heart andLetters to the Editor
thoracic aorta surgery: comparison
between Parsonnet and EuroSCORE
additive model. Eur J Cardiothorac
Surg 2001;20(5):961–6.
4. Pitkanen O, Niskanen M, Rehnberg Set al. Intra-institutional prediction ofoutcome after cardiac surgery: comparison between a locally derived
model and the EuroSCORE. Eur J
Cardiothorac Surg 2000;18(6):703–10.
5. Sergeant P, de Worm E, Meyns B et al.
The challenge of departmental quality
control in the reengineering towards
off-pump coronary artery bypass
grafting. Eur J Cardiothorac Surg 2001;
20(3):538–43.

F. Roques
CHU Fort-de-France
MartiniqueFrance
P. Michel
12 Rue Dubernat
33404 Talence CedexFrance
A.R. Goldstone
S.A.M. Nashef
Papworth Hospital
Cambridge CB3 8REUK