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

 
Input
 
NYHA Class  
eGFR  
Hemoglobin  
Procedure Nonurgent (0)

Urgent (1)
Active Endocarditis No (0)

Yes (1)
Prior Sternotomies Less than 2 (0)

2 or more (1)
ACHS Score*  

 
Result
 
 
PEACH 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 PubMed Logo
  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 PubMed Logo
  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 PubMed Logo

 
Associated Medical Subject Headings [MeSH]
 
         Adult,   Age Factors,   Bayes Theorem,   Chronic,   Chronic Disease,   Congenital,   Creatinine,   Cross-Sectional Studies,   Databases,   Ethnic Groups,   Factual,   Female,   Glomerular Filtration Rate,   Health Care,   Heart Defects,   Hospital Mortality,   Humans,   Kidney Failure,   Male,   Medical,   Middle Aged,   Nonparametric,   Outcome Assessment,   Regression Analysis,   Risk Adjustment,   Serum Albumin,   Sex Factors,   Societies,   Statistics,   Survival Rate,   Thoracic Surgery,   Thoracic Surgical Procedures,   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.

 
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