The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study.
The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study.
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DOI：
10.1097/eja.0000000000000845
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发表时间：
2018-09
影响因子：
3.6
通讯作者：
LAS VEGAS
中科院分区：
文献类型：
--
作者：
Neto AS;da Costa LGV;Hemmes SNT;Canet J;Hedenstierna G;Jaber S;Hiesmayr M;Hollmann MW;Mills GH;Vidal Melo MF;Pearse R;Putensen C;Schmid W;Severgnini P;Wrigge H;Gama de Abreu M;Pelosi P;Schultz MJ;LAS VEGAS
目前使用的术后肺部并发症（PPC）术前预测评分仅使用患者数据和预期手术特征。然而，术中事件也与PPC的发生相关。我们的目标是使用术前和术中数据为PPC开发一种新的预测评分。这是一项大型国际、多中心、前瞻性研究拉斯维加斯研究的次要分析。29个国家的146家医院。手术全麻期间需要术中通气的成人患者。将队列随机分为开发子样本以构建预测模型，以及子样本以进行验证。开发的PPC模型的预测性能。在分析的6063例患者中，10.9%发生了至少1例PPC。回归模型确定了PPC的13个独立风险因素：6个患者特征[年龄较大、美国麻醉学会（阿萨）体格评分较高、术前贫血、术前SpO 2较低和活动性癌症或阻塞性睡眠呼吸暂停病史]、2个手术相关特征（紧急或急诊手术以及手术持续时间≥ 1小时），以及5起术中事件[使用除声门上装置以外的气道，使用静脉麻醉剂沿着挥发性药物（平衡麻醉）、术中去饱和、较高水平的呼气末正压> 3 cm H2O和使用血管加压药]。开发子样本预测PPC的拉斯维加斯风险评分的受试者工作特征曲线下面积为0. 78 [95%置信区间（95% CI），0. 76 - 0. 80]，验证子样本为0. 72（95% CI，0. 69 - 0. 76）。包括13个围手术期特征的拉斯维加斯风险评分对PPC的预测具有中等区分能力。在临床实践中使用之前需要进行外部验证。该研究在Clinicaltrials.gov上注册，编号为NCT 01601223。
Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs. We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data. This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study. A total of 146 hospitals across 29 countries. Adult patients requiring intra-operative ventilation during general anaesthesia for surgery. The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation. Prediction performance of developed models for PPCs. Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intraoperative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample. The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice. The study was registered at Clinicaltrials.gov, number NCT01601223.