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. 2023 Jul 28:10:1192300.
doi: 10.3389/fcvm.2023.1192300. eCollection 2023.

External validation of the REMEMBER score

Armin Darius Peivandi  1 , Henryk Welp  1 , Sebastian Kintrup  2 , Nana Maria Wagner #  2 , Angelo Maria Dell'Aquila #  1
Affiliations

External validation of the REMEMBER score

Armin Darius Peivandi et al. Front Cardiovasc Med. .

Abstract

Background: The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is associated with high in-hospital mortality rates. The pRedicting mortality in patients undergoing venoarterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score has been created to predict in-hospital mortality in this subgroup of patients. The aim of this study is to externally validate the REMEMBER score.

Methods: All CABG patients who received VA-ECMO during or after the operation at our center between 01/2012 and 12/2021 were included in the analysis. Discrimination was assessed using concordance statistics, visualized by ROC curve analysis. Calibration-in-the-large and Calibration slope were tested separately.

Results: A total of 107 patients (male: n = 78, 72.9%) were included in this study. The in-hospital mortality rate in our cohort was 45.8% compared with 55% in the original study. The REMEMBER score median predicted mortality rate was 52% (76.9-36%). However, the REMEMBER score showed low discriminative ability [AUC: 0.623 (p = 0.0244; 95% CI = 0.524-0.715)] and inaccurate calibration (intercept = 0.25074; p = 0.0195; slope = 0.39504; p = 0.0303), indicating poor performance.

Conclusions: The REMEMBER score did not predict in-hospital mortality and was therefore not applicable in our cohort of patients. Additional external validation studies in a multicenter setting are therefore advisable.

Keywords: cardiac failure; coronary artery bypass grafting; extracorporeal life support; risk score; score system.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Observed in-hospital mortality rates in different risk groups, built according to the original study from I (lowest risk) to IV (highest risk): risk group IV showed a lower in-hospital mortality rate than risk groups II and III, indicating a mortality overestimation by the score in higher values.
Figure 2
Figure 2
ROC curve showing low discrimination of the REMEMBER score in our cohort [AUC of 0.623 (p = 0.0244; 95% CI = 0.524–0.715)].
Figure 3
Figure 3
Calibration curve, demonstrating that low prediction values of the REMEMBER score underestimate mortality, while higher values overestimate the same [calibration-in large (intercept) 0.25074 (std. error 0.10566, t-value 2.3731, p = 0.0195), Slope 0.39504 (std. error 0.17991, t-value 2.1958, p = 0.0303)].
See this image and copyright information in PMC

References

    1. Raffa GM, Gelsomino S, Sluijpers N, Meani P, Alenizy K, Natour E, et al. In-hospital outcome of post-cardiotomy extracorporeal life support in adult patients: the 2007–2017 Maastricht experience. Crit Care Resusc. (2017) 19(Suppl 1):53–61. PMID: . - PubMed
    1. Biancari F, Dalén M, Perrotti A, Fiore A, Reichart D, Khodabandeh S, et al. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: results of a multicenter study. Int J Cardiol. (2017) 241:109–14. 10.1016/j.ijcard.2017.03.120 - DOI - PubMed
    1. Chung M, Zhao Y, Strom JB, Shen C, Yeh RW. Extracorporeal membrane oxygenation use in cardiogenic shock: impact of age on in-hospital mortality, length of stay, and costs. Crit Care Med. (2019) 47(3):e214–21. 10.1097/CCM.0000000000003631 - DOI - PMC - PubMed
    1. Wang L, Yang F, Wang X, Xie H, Fan E, Ogino M, et al. Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score. Crit Care. (2019) 23(1):11. 10.1186/s13054-019-2307-y - DOI - PMC - PubMed
    1. Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. (2015) 350:g7594. 10.1136/bmj.g7594 - DOI - PubMed

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