Abstract Introduction: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.

Taxus baccata é uma espécie nativa das florestas do Cáspio e é considerada como a identificação dessas florestas por alguns recursos. O objetivo deste estudo foi compreender as características ecológicas de T. baccata visando encontrar áreas adequadas para seu cultivo no parque Pone Aram da província de Golestan. Para isto, foram utilizados métodos de avaliação de diferentes critérios baseados no processo hierárquico de análise. A princípio, neste processo os índices naturais necessários e eficazes foram usados como 10 parâmetros. Em seguida, o mapa final de áreas adequadas para o plantio de T. baccata foi produzido com base nos modelos de Bolian e MCE. De acordo com os resultados do modelo de Bolian, aproxidamente 6218 ha da área total do local de estudo (30.554ha) foram estimados como adequados e semi adequados e 24.336ha foram estimados como impróprios pelo modelo MCE. Isto mostrou que, de toda a área de estudo, 30.554ha, cerca de 2.482 são adequados para plantação de T. baccata e 6181ha não são adequados para o plantio de T. baccata. Considerando os resultados dos métodos de MCE e Bolian concluiu-se que, para os parâmetros ecológicos dinâmicos em delimitação de áreas adequadas para plantação de T. baccata plantação de MCE é mais apropriado do que de Bolian. Usando os resultados deste estudo, é possível adequar áreas para T. baccata e executar um plano para facilitar o plantio de T. baccata em florestas do norte do Irã (bacias hidrográficas 88).

Taxus baccata is a native species to the Caspian forests and is considered as the identification of these forests by some resources. The aim of this study was to understand the ecological characteristics of T. baccata in order to find suitable areas for its plantation in the Pone Aram preserve of Golestan province. Therefore, Multi-Criteria Evaluation (MCE) methods based on Analytical Hierarchy Process (AHP) were used. In this process at first the needed and effective natural indexes were used as 10 parameters. Then the final map of suitable areas for T. baccata plantation were produced based on Bolian and MCE models. According to the results, in Bolian method about 6218 ha of the total area of the study site (30554 ha) were estimated as suitable and semi suitable and 24336 ha were estimated as unsuitable for MCE model showed that about 2482 ha of the whole 30554 ha area of the study site is adequate for T. baccata plantation and 6181 ha is not adequate for T. baccata plantation. Regarding the results of the MCE and Bolian methods it has been concluded that for dynamic ecological parameters in delineation of suitable areas for T. baccata plantation the MCE weighting is more appropriate than Bolian. Using the results of this investigation it is possible to adequate areas for the presence of T. baccata and to execute a plan in order to facilitate the plantation of T. baccata in northern forests of Iran (watershed 88).