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PEACH Score: Estimating Perioperative Mortality in Adult Congenital Heart Disease Surgery

 

Input
 

NYHA Class		# count index logit none number points score
eGFR		mL/min/1.73 m(2) mL/min/1.73 m2 mL/min/1.73 m^2 mL/min/1.73m2 mL/sec/1.73 m^2
Hemoglobin		g/L g/dL gm/L gm/dL mcg/dL mcg/mL mg% mg/dL mg/mL ng/mL
Procedure	Nonurgent (0)
	Urgent (1)
Active Endocarditis	No (0)
	Yes (1)
Prior Sternotomies	Less than 2 (0)
	2 or more (1)
ACHS Score*	ASD (0.1) Pacemaker procedure (0.2) PAPVC repair (0.2) Aortic stenosis, subvalvar (0.2) Conduit reoperation (0.2) PV replacement (0.2) Anomalous coronary from aorta repair (0.3) Explantation of pacing system (0.3) AICD procedure (0.3) Pacemaker implantation, permanent (0.3) AV repair (0.3) AICD implantation (0.3) Vascular ring repair (0.3) Ebstein’s repair (0.3) MV repair (0.4) Konno procedure (0.4) PA reconstruction (0.4) Pulmonic valvuloplasty (0.4) Sinus of Valsalva aneurysm (0.4) RVOT repair (0.4) Anomalous coronary artery from pulmonary artery (0.4) Valve-sparing aortic root replacement (0.4) PAPVC scimitar (0.4) Aortic stenosis, supravalvar (0.4) RV aneurysm (0.4) DCRV (0.4) VSD (0.5) Common AV canal repair (incomplete) (0.5) Aortic arch repair (0.5) AV replacement (0.6) Aortic aneurysm (0.6) TV repair (0.6) Systemic venous stenosis repair (0.6) TOF repair (0.6) Ross procedure (0.7) Conduit RV-PA (0.7) Arrhythmia, surgical ablation, ventricular (0.7) Pericardial drainage (0.8) Arrhythmia, surgical ablation, atrial (0.8) Coarctation repair (0.8) Conduit placement, other (0.9) TV replacement (0.9) Shunt, systemic to pulmonary (0.9) Aortic root replacement, non–valve-sparing (1.0) ASD creation or enlargement (1.0) MV replacement (1.5) Cardiac tumor resection (1.5) Coronary artery bypass (1.6) Fontan procedure (1.8) Fontan revision (3.0)

 
Result
 
Important: Inputs must be complete to perform calculation.

 

PEACH Score		# count index logit none number points score

 

     
 
Include literature references: Yes   No

 

PEACH Score Interpretation

 

Points	Category	Mortality	Confindence interval¶
0	Low risk	In-hospital mortality 0.2%	0.02 to 0.6%
1 to 2	Intermediate risk	In-hospital mortality 3.6%	2.2 to 5.7%
3 to 7	High risk	In-hospital mortality 17.2%	8.9 to 28.7%

 

 

 

Notes

• In this calculator, mcg is the abbreviation for micrograms.
• * In the Constantine study^[1,2] heart and lung transplant surgeries were excluded. Additionally, eGFR was calculated using the abbreviated MDRD study equation.^[1,3]
• ¶ Confidence intervals from the observed development cohort.^[1]
• If >1 procedure is planned during the same operation, the procedure with the higher score should be selected in the ACHS Score..
• PEACH: PErioperative ACHd; NYHA: New York Heart Association; ACHS: adult congenital heart disease surgery; eGFR: estimated glomerular filtration rate; MDRD: Modification of Diet in Renal Disease.

 
Equations used
 

PEACHScore = NYHAFactor + eGFRFactor + HemoglobinFactor + Procedure + ActiveEndocarditis + PriorSternotomies + Math.abs(ACHS Score* ≥ 1.6)

 

 

Calculation Details and Variables

• NYHAFactor is assigned values by this ordered logic:
  • If NYHA Class ≥3 score NYHAFactor = 1
  • Else NYHAFactor = 0.
• eGFRFactor is assigned values by this ordered logic:
  • If eGFR <60 mL/min/1.73 m(2) eGFRFactor = 1
  • Else eGFRFactor = 0.
• HemoglobinFactor is assigned values by this ordered logic:
  • If Hemoglobin <10 g/dL HemoglobinFactor = 1
  • Else if Hemoglobin >20 g/dL HemoglobinFactor = 1
  • Else HemoglobinFactor = 0.
• ACHS Factor is assigned 1 point if the ACHS Score ≥ 1.6. Otherwise, the ACHS Factor is set to 0.
• Equation parameters such as Procedure, have two or more discrete values that may be used in the calculation. The numbers in the parentheses, e.g. (0), represent the values that will be used.

 

References

1. Constantine A, Costola G, Bianchi P, et al. Enhanced Assessment of Perioperative Mortality Risk in Adults With Congenital Heart Disease. J Am Coll Cardiol. 2021 Jul 20;78(3):234-242. PubMed ID: 34266577
2. Fuller SM, He X, Jacobs JP, et al. Estimating Mortality Risk for Adult Congenital Heart Surgery: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2015 Nov;100(5):1728-35. PubMed ID: 26411754
3. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Int Med. 1999 Mar 16;130(6):461-70. PubMed ID: 10075613

 

Associated Medical Subject Headings [MeSH]
 

Adult,   Age Factors,   Bayes Theorem,   Cardiac Surgical Procedures,   Chronic,   Chronic Disease,   Congenital,   Creatinine,   Cross-Sectional Studies,   Databases,   Ethnic Groups,   Factual,   Female,   Follow-Up Studies,   Glomerular Filtration Rate,   Health Care,   Heart Defects,   Hospital Mortality,   Humans,   Kidney Failure,   Male,   Medical,   Middle Aged,   Nonparametric,   Outcome Assessment,   ROC Curve,   Regression Analysis,   Retrospective Studies,   Risk Adjustment,   Risk Assessment,   Risk Factors,   Serum Albumin,   Sex Factors,   Societies,   Statistics,   Survival Rate,   Thoracic Surgery,   Thoracic Surgical Procedures,   United Kingdom,   United States,   Urea,   Young Adult

 

Associated Logical Observation Identifiers Names and Codes [LOINC]
 

Parameter	LOINC's and Suggested Units
NYHA Class	88020-3 : score
eGFR	77147-7 : mL/min/1.73m2      48643-1 : mL/min/1.73m2      48642-3 : mL/min/1.73m2      69405-9 : mL/min/1.73m2      62238-1 : mL/min/1.73m2
Hemoglobin	718-7 : g/dL      718-7 : gm/dL      59260-0 : mmol/L

 
This material contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyright © 1995-2014, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and available at no cost under the license at http://loinc.org/terms-of-use.