Scrutinio 2014.

Study characteristics
General information	Objective  Added biomarkers, prediction model compared Journal Annals of Vascular Surgery Country Italy Study design Prospective cohort study
Participants	Number of included patients 411 Surgical specialty Vascular surgery Age Mean 70.2 years (SD 9.4 years) Male sex 78.8% High‐risk surgery Not reported   Insulin‐dependent diabetes mellitus 16.8% History of ischaemic heart disease 27.7% History of congestive heart failure 4.4% History of cerebrovascular events 17.8% Elevated creatinine 9.5% 0 RCRI factors Not reported 1 RCRI factor Not reported 2 RCRI factors Not reported 3 or more RCRI factors Not reported
Predictors	Predictor 1: NT‐proBNP  Objective: added biomarker  Category: blood Scale: continuous Threshold: not applicable Assay/device: not reported   Predictor 2: High‐sensitivity CRP  Objective: added biomarker  Category: blood Scale: continuous Threshold: not applicable Assay/device: Dimension RxL immunoassay (Siemens Healthcare Diagnostics, Glasgow, DE)   Predictor 3: NT‐proBNP+ high‐sensitivity CRP  Objective: added biomarker  Category: blood Scale: continuous Threshold: not applicable Assay/device: Dimension RxL immunoassay (Siemens Healthcare Diagnostics, Glasgow, DE)   Predictor 4: New developed prediction model including insulin therapy for diabetes, open surgery and the highest tertiles of fibrinogen (> 377 mg/dL), hs‐CRP (> 3.2 mg/L) and NT‐proBNP (> 221 ng/L) Objective: prediction model compared Category: prediction model Scale: not applicable Threshold: not applicable Assay/device: not applicable
Outcome	Outcome category All‐cause mortality and MACE Full outcome definition Composite of death, acute coronary syndromes, acute pulmonary oedema within 30 days of surgery and postoperative myocardial damage Prediction horizon 30‐day events
Analysis	Number of outcomes 74 Handling missing data No information on handling missing data Discrimination reported? Yes Calibration reported? Yes Reclassification reported? Yes
PROBAST: Applicability	Domain 1: Participant selection Low Justification: patient selection was appropriate and generalisable to the population used in the RCRI development study Domain 2: Predictors Low Justification: predictor definitions were clearly defined and comparable to the definitions used in the development study Domain 3: Outcome Low Justification: outcome definitions were clearly defined and comparable to the definitions used in the development study Overall judgement: Low Patient selected were generalisable to the patient population used in the RCRI development study. Predictor and outcome definitions were clearly defined/assessed and comparable to the definitions used in the RCRI development study.
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	Yes	Although only patients undergoing vascular surgery were included, participant selection was appropriate and the RCRI model can be applied in these patients.
Domain 2: Predictors	Yes	Clear (RCRI) predictor definitions were described.
Domain 3: Outcome	Yes	Clearly defined outcome definitions and appropriate adjudication of outcomes.
Domain 4:  Analysis	No	Low number of outcomes and no information on handling missing data.
Overall judgement	No	Patient selection was appropriate. Predictors and outcomes were clearly defined and assessed. However, the number of outcomes was low and there was no information on missing data.