Risk of Assessing Mortality Risk in Elective Cardiac Operations Age, Creatinine, Ejection Fraction, and the Law of Parsimony
Risk of Assessing Mortality Risk in Elective Cardiac Operations Age, Creatinine, Ejection Fraction, and the Law of Parsimony
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DOI：
10.1161/circulationaha.108.842393
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发表时间：
2009-06-23
期刊：
影响因子：
37.8
通讯作者：
Pelissero, Gabriele
中科院分区：
文献类型：
--
作者：
Ranucci, Marco;Castelvecchio, Serenella;Pelissero, Gabriele
心脏手术中存在几种死亡风险评分。所有这些都包括相当多的独立风险因素。在择期心脏手术患者中，手术死亡率低，每年记录的事件数量有限，风险模型可能过拟合。本研究的目的是开发和验证手术死亡率风险评分的基础上，选择有限的factors.Methods和Results-The发展系列包括4557例成年患者谁经历了选择性心脏手术在我们的机构从2001年至2003年，验证系列包括4091例患者谁随后接受了手术。死亡风险模型包括三个独立因素：年龄、肌酐和左心室射血分数（ACEF）。ACEF评分计算如下：年龄（岁）/射血分数（%）+ 1（如果血清肌酐值> 2 mg/dL）。ACEF评分与验证系列中的其他5个风险评分进行比较。鉴别力（准确性）定义与受试者操作特征分析。准确性最好的是克利夫兰诊所评分（0.812），ACEF评分略低于它（0.808）。在冠状动脉手术中，2个评分表现同样良好在孤立性冠状动脉手术中，ACEF的准确性最高（0.826），Cleveland Clinic评分为0.806。结论：与复杂的风险评分相比，仅限于3个独立预测因子的风险模型在择期心脏手术中具有相似或更好的准确性和校准性。（循环。2009; 119：3053-3061）。
Background-Several mortality risk scores exist in cardiac surgery. All include a considerable number of independent risk factors. In elective cardiac surgery patients, the operative mortality is low, the number of events recorded per year is limited, and the risk model may be overfitted. The present study aims to develop and validate an operative mortality risk score for elective patients based on a limited number of factors.Methods and Results-The development series included 4557 adult patients who had undergone an elective cardiac operation at our institution from 2001 to 2003; the validation series includes the 4091 patients who subsequently underwent an operation. Three independent factors were included in the mortality risk model: age, creatinine, and left ventricular ejection fraction (ACEF). The ACEF score was computed as follows: age (years)/ejection fraction (%) + 1 (if serum creatinine value was > 2 mg/dL). The ACEF score was compared with 5 other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics analysis. The best accuracy was achieved by the Cleveland Clinic score (0.812), with ACEF score just below it (0.808). In coronary operations, the 2 scores performed equally well (0.815 versus 0.813), and in isolated coronary operations, the best accuracy was achieved by ACEF (0.826), with the Cleveland Clinic score at 0.806.Conclusion-A risk model limited to 3 independent predictors has similar or better accuracy and calibration compared with more complex risk scores if applied to elective cardiac operations. (Circulation. 2009; 119: 3053-3061.)