Gupta Risk Calculator

Are you a cardiac patient and want to assess a patient’s risk for any cardiac incident in the perioperative period? This article on the Gupta risk calculator is for you to evaluate the incidence of cardiac events, including cardiac arrest or myocardial infarction, during the perioperative period. The perioperative period is a phase before and around any major or minor surgery. It includes preoperative, operative, and postoperative time lapses.

The Gupta risk calculator evaluates the risk for major cardiac problems (myocardial infarction or cardiac arrest) and determines a person’s need for cardiac monitoring. This article is about the Gupta risk calculator formula, score interpretation, and the proper usage of this calculator to evaluate perioperative risk.  Let us have a deep look at the critical aspects of the Gupta risk calculator.

What is the Gupta perioperative risk?

Perioperative myocardial infarction or cardiac arrest can result in increased morbidity and mortality rate. Therefore, a proper study was conducted by Gupta et Al. to evaluate the risk of these cardiac events happening in the perioperative period. There are five primary predictors that were identified to limit perioperative myocardial infarction or cardiac arrest. These are as follows:

• Type of surgery
• Dependent functional status
• Creatinine levels
• American Society of Anesthesiologists (ASA) class
• Age group

The perioperative period is important for major cardiac events to happen. The Gupta risk calculator is a diagnostic tool for such patients to assess the risk of myocardial infarction or cardiac arrest to occur. The perioperative period ranges from the time of surgery to the 30 days after surgery. It is not dependent only on cardiac surgeries. Any kind of surgery can increase the risk of myocardial infarction or cardiac arrest. This Gupta perioperative risk is also dependent on the patient’s overall health, age, kidney functioning, and type of surgery.

The Gupta risk calculator does not bother about the risk factors (low-density lipid levels or smoking) associated with cardiac events. But, it is totally inclined toward the type of surgery. The result obtained by this calculator helps to differentiate such patients who require more careful monitoring regarding their cardiac functions.

Is there any use of the Gupta risk calculator in clinical practice?

Patients with high Gupta risk scores require additional care and monitoring during and after the surgery to prevent any major cardiac emergency. Monitoring services may include stress testing, echocardiogram, ECG, heart rate calculation on ECG, and proper consultation with a cardiologist. In contrast, people with low Gupta risk scores do not need any additional monitoring or cardiac tests. Considering these facts, the Gupta risk calculator is a beneficial tool to know about the chances of any cardiac event during or after the surgery.

What is the equation formula for the Gupta risk calculator?

The Gupta risk calculator follows the following equation formula to assess the risk of myocardial infarction or cardiac arrest.

Cardiac risk in percentage = eⁿ ÷ (1 +eⁿ)

n = age × 0.02 + status + ASA class + creatinine level + type – 5.25

n is dependent on five basic parameters. Let us discuss these parameters in detail.

• Age of the patient multiplied with 0.02
• Status of the patient indicates the condition after the surgery. It means whether the patient is functioning properly or not.
  • Totally independent patient = 0
  • Partially independent = 0.65
  • Totally dependent = 1.03
• ASA indicates the American Society of Anesthesiologists classification. The ASA classification is as follows:
  • Class 1 indicates a healthy patient = -5.17 points
  • Class 2 indicates mild systemic disease  = -3.29 points
  • Class 3 indicates severe systemic disease = -1.92 points
  • Class 4 denotes a severe systemic disease that can put a patient’s life at the risk of death = -0.95 points
  • Class 5 indicates a moribund patient or who is not expected to survive without a surgery = 0 points 
• Creatinine levels:
  • Normal creatinine level = ≤1.5 mg/dL or 133 μmol/L = 0 points
  • Increased creatinine levels = > 1.5 mg/dL or 133 μmop/L = 0.61 points
• Type of surgery:
  • Hernia: ventral, inguinal, femoral, and other = 0 points
  • Anorectal: anus and rectum = -0.16 points
  • Aortic = 1.6 points
  • Bariatric = -0.25points
  • Brain = 1.4 points
  • Breast = -1.61 points
  • Cardiac: Heart = 1.01 points
  • ENT, except thyroid and parathyroid = 0.71 points
  • Foregut/hepato-pancreaticobiliary: esophagus, stomach, duodenum, pancreas, liver, and biliary tree (except isolated cholecystectomy) = 1.39 points
  • Gallbladder, appendix, adrenals, spleen, biliary tree surgeries other than cholecystectomy not included = 0.59 points
  • Intestinal, below the level of the duodenum = 1.14 points
  • Neck, including thyroid and parathyroid = 0.18 points
  • Obstetric or gynecologic = 0.76 points
  • Orthopedic = 0.8 points
  • Abdomen, other = 1.13 pointsPeripheral vascular, non-aortic, non-vein vascular surgeries = 0.86 points
  • Skin = 0.54 points
  • Spine = 0.21points
  • Thoracic, except esophageal and cardiac = 0.4 points
  • Vein = -1.09 points
  • Urology, kidneys and urinary system = -0.26 points

These types of surgeries are not a risk factor for myocardial infarction or cardiac arrest. But they have a strong impact in the perioperative period to cause myocardial infarction or cardiac arrest.

Interpretation of the Gupta risk calculator

As we have known about the calculation formula, it is also important to know about the percentage ranges of the Gupta risk calculator. Patients with a high risk of myocardial infarction or cardiac arrest have a Gupta risk score of above 1%. These patients require additional monitoring and management during and after the surgery.

Myocardial infarction cardiac arrest risk:	Percentile:
0.05%	<25th
0.05 – 0.14%	26th to 50th
0.14 -1.47%	51st to 90th
1.47 – 2.60%	91st to 95th
2.60 – 7.69%	96th to 97th
7.69%	97th

How to use the Gupta risk calculator in clinical practice?

Let us take an example to understand the use of the Gupta risk calculator.

Jasmine, 65 years old, needs to undergo an appendectomy. She needs a bit of help from her helper to take care of her house due to a mild systemic disease. Her creatinine levels are ranging up to 1 mg/dL. Prior to surgery, her physician wants to evaluate the risk of myocardial infarction or cardiac arrest during and after surgery. What will be her Gupta risk score?

• Age = 65 years
• Status: partially dependent (0.65)
• ASA class = class 2 ( -3.29)
• Creatinine level = 1 mg/dL (0)
• Type of surgery = appendectomy = 0.59
  • n = 76 × 0.02 + 0.65 + (-3.29) + 0 +0.59 -5.25
  • n = -5.79
• Cardiac risk in percentage = e^-5.7 / (1 + e^-5.7)
• Cardiac risk = 1.0%

Hence, the cardiac risk lows between the 51st to 90th percentile.

Conclusion

The Gupta risk calculator assesses the risk of myocardial infarction and cardiac arrest during or after the surgery. Different surgeries have a strong impact on the increased prevalence of myocardial infarction or cardiac arrest. In addition, this calculator is dependent on the type of surgery and various other factors. This article covers all important details relevant to the Gupta risk calculator. Focus on the important details to know how to use this Gupta risk calculator.

Frequently asked questions (FAQs)