Handke 2019.

Study characteristics
General information	Objective  Biomarkers compared Journal Anesthesia and Analgesia Country Germany Study design Prospective cohort study
Participants	Number of included patients 38 Surgical specialty Noncardiac surgery Age Mean 69 years (SD 8.2 years) Male sex 82% High‐risk surgery 42%      Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease Not reported  History of congestive heart failure 3% History of cerebrovascular events Not reported Elevated creatinine Not reported 0 RCRI factors 0% 1 RCRI factor 11% 2 RCRI factors 45% 3 or more RCRI factors 45%
Predictors	Predictor 1: High‐sensitivity troponin T Objective: biomarker compared Category: blood Scale: dichotomous Threshold: 14 pg/ml Assay/device: Cobas E4111, Roche Diagnostics, Mannheim, Germany   Predictor 2: NT‐proBNP Objective: biomarker compared Category: blood Scale: dichotomous Threshold: 300 ng/ml Assay/device: Immulite, Siemens Health care Diagnostics, Erlangen, Germany   Predictor 3: eGFR (KDIGO stage ≥ 3) Objective: biomarker compared Category: blood Scale: dichotomous Threshold: 60 ml/min Assay/device: not applicable   Predictor 4: Presepsin Objective: biomarker compared Category: blood Scale: dichotomous Threshold: 184 pg/ml Assay/device: noncompetitive immunoassay on the PATHFAST analyzer (LSI Medience, Tokyo, Japan)
Outcome	Outcome category MACE Full outcome definition Cardiovascular death, myocardial infarction, myocardial ischaemia or stroke Prediction horizon 30‐day events
Analysis	Number of outcomes 5           Handling missing data In case of missing laboratory values, last measurement carried forward Discrimination reported? No Calibration reported? No   Reclassification reported? No
PROBAST: Applicability	Domain 1: Participant selection High Justification: only included participants with coronary artery disease Domain 2: Predictors Unclear Justification: no information on how the RCRI predictors were defined Domain 3: Outcome High Justification: outcome definition of MACE is different from the outcome in the development study as it includes e.g. stroke and myocardial ischaemia Overall judgement High Justification: only a selected group of patients was included, there was no/unclear information on predictor definitions and outcome definition was different compared to the development study
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	Yes	Appropriate participant selection in which patients were selected in whom the RCRI model can be applied.
Domain 2: Predictors	Unclear	No information on how the RCRI predictors were defined.
Domain 3: Outcome	Yes	Clearly defined outcome definitions and appropriate adjudication of outcomes.
Domain 4:  Analysis	No	Low number of included patients and outcomes, dichotomisation of continuous variables, no predictive performance measures reported that compared the RCRI with predictors.
Overall judgement	No	Patient selection was appropriate. Outcomes were clearly defined and assessed. However, predictors definitions were not clear/reported. Furthermore, the number of outcomes was low, dichotomisation of continuous variables and inappropriate reporting of performance measures.