Validation of the PIII CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous vein bypass for critical limb ischemia
Validation of the PIII CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous vein bypass for critical limb ischemia
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DOI：
10.1016/j.jvs.2009.05.055
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发表时间：
2009-10-01
影响因子：
4.3
通讯作者：
Conte, Michael S.
中科院分区：
文献类型：
--
作者：
Schanzer, Andres;Goodney, Philip P.;Conte, Michael S.
目的：PREVENT III（PIII）严重肢体缺血（CLI）风险评分是一种来自PIII随机临床试验的简单、已发表的工具，可用于估计考虑行腹股沟下旁路术（IB）的CLI患者的无截肢生存率（AFS）。目前的研究试图验证这一风险分层模型，使用前瞻性收集的数据北方新英格兰血管研究组（VSGNNE）方法：我们计算了1166例患者的PIII CLI风险评分，这些患者在2003年1月1日至2007年12月31日期间接受了11家医院的59名外科医生的自体静脉IB。根据透析（4例患者）、组织缺损（3例患者）、年龄≥ 75岁（2例患者）和冠状动脉疾病（CAD）（1例患者）为每位患者分配分数（pts）。由于缺失值比例较大，未纳入基线红细胞压积。使用总评分将每例患者分为低风险（≥ 8例患者）类别。采用Kaplan-Meier方法计算三个风险组的AFS。组间比较采用对数秩检验。为了评估验证，比较的PIII推导和验证setwerperformed.Result：分层的VSGNNE患者的风险类别产生了三个显着不同的估计1年AFS（86.4%，74.0%和56.1%，低，中，高风险组）。组间比较显示了精确的区分（P < .0001）。对于给定的风险类别，（低、中或高），VSGNNE数据集中的1年AFS估计值与先前发表的PIII推导集中观察到的一致（分别为85.9%、73.0%和44.6%），PIII验证集（分别为87.7%、63.7%和45.0%）和回顾性多中心验证集（分别为86.3%、70.1%和47.8%）。PIII CLI风险评分现已通过与在94家机构接受自体静脉旁路术的3286名CLI患者的结局进行测试而在内部和外部得到验证，这些患者由不同的医生进行（三个独立的患者队列）。该工具提供了一种简单可靠的方法来对考虑接受IB治疗的CLI患者进行风险分层。在初次咨询时，计算PIII CLI风险评分可以根据患者1年时的死亡或大截肢风险对患者进行可靠分层。（J Vasc Surg 2009;50：769-75.）
Objective: The PREVENT III (PIII) critical limb ischemia (CLI) risk score is a simple, published tool derived from the PIII randomized clinical trial that can be used for estimating amputation-free survival (AFS) in CLI patients considered for infrainguinal bypass (IB). The current study sought to validate this risk stratification model using data from the prospectively collected Vascular Study Group of Northern New England (VSGNNE).Method: We calculated the PIII CLI risk score for 1166 patients undergoing IB with autogenous vein by 59 surgeons at 11 hospitals between January 1, 2003, and December 31, 2007. Points (pts) were assigned to each patient for the presence of dialysis (4 pts), tissue loss (3 pts), age >= 75 (2 pts), and coronary artery disease (CAD) (1 pt). Baseline hematocrit was not included due to a large proportion of missing values. Total scores were used to stratify each patient into low-risk (= 8 pts) categories. The Kaplan-Meier method was used to calculate AFS for the three risk groups. Log-rank test was used for intergroup comparisons. To assess validation, comparison to the PIII derivation and validation sets was performed.Result: Stratification of the VSGNNE patients by risk category yielded three significantly different estimates for 1-year AFS (86.4%, 74.0%, and 56.1%, for low-, med-, and high-risk groups). Intergroup comparison demonstrated precise discrimination (P < .0001). For a given risk category (low, med, or high), the 1-year AFS estimates in the VSGNNE dataset were consistent with those observed in the previously published PIII derivation set (85.9%, 73.0%, and 44.6%, respectively), PIII validation set (87.7%, 63.7%, and 45.0%, respectively), and retrospective multicenter validation set (86.3%, 70.1%, and 47.8%, respectively).Conclusion: The PIII CLI risk score has now been both internally and externally validated by testing it against the outcomes of 3286 CLI patients who underwent autogenous vein bypass at 94 institutions by a diverse array of physicians (three independent cohorts of patients). This tool provides a simple and reliable method to risk stratify CLI patients being considered for IB. At initial consultation, calculation of the PIII CLI risk score can reliably stratify patients according to their risk of death or major amputation at 1 year. (J Vasc Surg 2009;50:769-75.)