The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients
The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients
复制标题
DOI：
10.1007/s12630-013-9988-5
复制
发表时间：
2013-09-01
影响因子：
4.2
通讯作者：
Beattie, W. Scott
中科院分区：
文献类型：
--
作者：
Davis, Christopher;Tait, Gordon;Beattie, W. Scott
非心脏手术后的心脏并发症是发病率和死亡率的主要原因。修订后的心脏风险指数（RCRI）已成为预测术后心脏并发症的标准。这项研究重新审查了原来的六个风险因素，以确认它们在大型现代前瞻性数据库中的有效性。使用原始风险指数中的定义，这项研究包括 9,519 名年龄为 50 日元的患者，他们在两家主要三级护理医院接受择期非心脏手术，预计住院时间为 1000 日元 2 天。使用二项式逻辑回归模型、受试者工作曲线下面积 (ROC) 分析和净重分类指数测试了原始预测变量的有效性。在我们的患者队列中，预测变量为 0、1、2、千分之 3 的主要心脏并发症发生率分别为 0.5%、2.6%、7.2% 和 14.4%，而 0.4%、1.1%、 4.6%, 在原始队列中分别为 9.7% 和 9.7%。与原始报告类似，二元 Logistic 回归分析显示，术前胰岛素治疗（比值比 [OR] 1.4；95% 置信区间 [CI] 0.7 至 2.6）和术前肌酐 > 176.8 mmol 中心点 L-1（OR 1.7；95% CI 0.8 至 3.6）均未提高该指数的预测能力。对其余四个因素的分析得出的曲线下面积 (AUC) 与重建的六因素 RCRI 的曲线下面积 (AUC = 0.79) 相同。我们发现肾小球滤过率 (GFR) < 30 mL 中心点 min(-1) 比肌酐 > 176.8 mmol 中心点 L-1 更能预测主要心脏并发症（OR 2.2；95% CI 1.2 至 4.3）。由此产生的 5 因素模型的接受者操作特征分析得出 AUC 为 0.79，在我们的患者队列中，预测因子分别为 0、1、2、千分之 3，分别代表 0.5%、2.9%、7.4% 和 17.0% 的风险。与 RCRI 相比，使用高风险手术类型、缺血性心脏病史的简化 5 因素模型疾病、充血性心力衰竭、 脑血管疾病和术前 GFR < 30 mL 中心点 min(-1) 可以更好地预测选择性非心脏手术后的主要心脏并发症。
Cardiac complications following non-cardiac surgery are major causes of morbidity and mortality. The Revised Cardiac Risk Index (RCRI) has become a standard for predicting post-surgical cardiac complications. This study re-examined the original six risk factors to confirm their validity in a large modern prospective database.Using the definitions in the original risk index, this study included 9,519 patients aged a parts per thousand yen 50 undergoing elective non-cardiac surgery with an expected length of stay a parts per thousand yen two days at two major tertiary-care teaching hospitals. The validity of the original predictors was tested in this population using binomial logistic regression modelling, area under the receiver operator curve (ROC) analysis, and the net reclassification index.Rates of major cardiac complications with 0, 1, 2, a parts per thousand yen 3 of the predictors were 0.5%, 2.6%, 7.2%, and 14.4%, respectively, in our patient cohort compared with 0.4%, 1.1%, 4.6%, and 9.7%, respectively, in the original cohort. Similar to the original report, binary logistic regression analysis showed that both preoperative treatment with insulin (odds ratio [OR] 1.4; 95% confidence interval [CI] 0.7 to 2.6) and preoperative creatinine > 176.8 mmol center dot L-1 (OR 1.7; 95% CI 0.8 to 3.6) did not improve the predictive ability of the index. Analysis of the remaining four factors resulted in an area under the curve (AUC) identical to that seen for the reconstructed six-factor RCRI (AUC = 0.79). We found that a glomerular filtration rate (GFR) < 30 mL center dot min(-1) was a better predictor of major cardiac complications (OR 2.2; 95% CI 1.2 to 4.3) than creatinine > 176.8 mmol center dot L-1. The receiver operating characteristic analysis of this resultant 5-Factor model resulted in an AUC of 0.79, with 0, 1, 2, a parts per thousand yen 3 of the predictors representing 0.5%, 2.9%, 7.4%, and 17.0% risk, respectively, among our patient cohort.Compared with the RCRI, a simplified 5-Factor model using a high-risk type of surgery, a history of ischemic heart disease, congestive heart failure, cerebrovascular disease, and a preoperative GFR < 30 mL center dot min(-1) results in superior prediction of major cardiac complications following elective non-cardiac surgery.