Validation of EuroSCORE II in a modern cohort of patients undergoing cardiac surgery
Validation of EuroSCORE II in a modern cohort of patients undergoing cardiac surgery
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DOI：
10.1093/ejcts/ezs406
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发表时间：
2013-04-01
影响因子：
3.4
通讯作者：
Poullis, Michael
中科院分区：
文献类型：
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作者：
Chalmers, John;Pullan, Mark;Poullis, Michael
我们的目的是在英国当代心脏外科实践中验证新的EuroSCORE II风险模型。在预测住院死亡率的准确性方面，将原始logistic EuroSCORE与EuroSCORE II进行比较。分析孤立冠状动脉旁路移植术（CABG, n = 2913）、主动脉瓣置换术（AVR, n = 814）、二尖瓣手术（MVR, n = 340）、AVR和CABG联合手术（n = 517）、主动脉瓣置换术（n = 350）和其他手术（n = 642）以及上述联合手术（n = 5576）。在单一机构的经验中，EuroSCORE II是孤立性CABG （C-statistic 0.79, Hosmer-Lemeshow P = 0.052）和主动脉手术（C-statistic 0.81, Hosmer-Lemeshow P = 0.43）的院内死亡率的合理风险模型，并且对于二尖瓣手术（C-statistic 0.87, Hosmer-Lemeshow P = 0.6）非常出色。使用AVR和CABG联合手术的同期数据，EuroSCORE II优于原始EuroSCORE （c统计值0.74,Hosmer-Lemeshow P = 0.38）。然而，对于孤立AVR （C-statistic 0.69, Hosmer-Lemeshow P = 0.07）和其他程序（C-statistic 0.70, Hosmer-Lemeshow P = 0.99）， EuroSCORE II未能改善原始EuroSCORE模型。对于累积和生存（CUSUM）曲线，EuroSCORE II比原始的EuroSCORE或英国和爱尔兰心胸外科学会（SCTS）修改的EuroSCORE有更好的校准。EuroSCORE II改进了原始的logistic EuroSCORE，尽管主要用于AVR和CABG合并病例。然而，对其在孤立AVR手术、主动脉手术和其他手术中的应用仍然存在担忧。风险建模仍有改进的空间。
We aimed to validate the new EuroSCORE II risk model in a contemporary cardiac surgery practice in the United Kingdom (UK).The original logistic EuroSCORE was compared to EuroSCORE II with regard to accuracy of predicting in-hospital mortality. Analysis was performed on isolated coronary artery bypass grafts (CABG; n = 2913), aortic valve replacement (AVR; n = 814), mitral valve surgery (MVR; n = 340), combined AVR and CABG (n = 517), aortic (n = 350) and miscellaneous procedures (n = 642), and the above cases combined (n = 5576).In a single-institution experience, EuroSCORE II is a reasonable risk model for in-hospital mortality from isolated CABG (C-statistic 0.79, Hosmer-Lemeshow P = 0.052) and aortic procedures (C-statistic 0.81, Hosmer-Lemeshow P = 0.43), and excellent for mitral valve surgery (C-statistic 0.87, Hosmer-Lemeshow P = 0.6). EuroSCORE II is better than the original EuroSCORE, using contemporaneous data for combined AVR and CABG operations (C-statistic 0.74, Hosmer-Lemeshow P = 0.38). However, EuroSCORE II failed to improve on the original EuroSCORE model for isolated AVR (C-statistic 0.69, Hosmer-Lemeshow P = 0.07) and miscellaneous procedures (C-statistic 0.70, Hosmer-Lemeshow P = 0.99). EuroSCORE II has better calibration than the original EuroSCORE or the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) modified EuroSCORE for cumulative sum survival (CUSUM) curves.EuroSCORE II improves on the original logistic EuroSCORE, though mainly for combined AVR and CABG cases. Concerns still exist, however, over its use for isolated AVR procedures, aortic surgery and miscellaneous procedures. There is still room for improvement in risk modelling.