Forced expiratory volume in one second predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery: a retrospective cohort study.
Forced expiratory volume in one second predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery: a retrospective cohort study.
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DOI：
10.1371/journal.pone.0064565
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Mills NL
中科院分区：
文献类型：
--
作者：
McAllister DA;Wild SH;MacLay JD;Robson A;Newby DE;MacNee W;Innes JA;Zamvar V;Mills NL
人口老龄化和经皮治疗的使用增加导致老年患者有更多的合并症被转诊接受心脏手术。需要客观测量生理储备和共病的严重程度，以改善危险分层。我们假设FEV 1可以预测心脏手术后的死亡率和住院时间。我们评估了2001年至2007年在区域心脏中心接受冠状动脉旁路移植术和/或瓣膜手术的2,241例连续患者的临床结局。FEV 1与住院时间和死亡率之间相关性的广义线性模型根据年龄、性别、身高、体重指数、社会经济状况、吸烟、心血管危险因素、长期使用支气管扩张剂或类固醇治疗肺部疾病以及手术类型和紧急程度进行调整。将FEV 1与已建立的风险预测模型EuroSCORE进行比较。在平均（SD）年龄为67（10）岁的2，082例患者（93%）中进行了肺量测定。FEV 1最低五分位数患者的中位住院时间比最高五分位数患者长3天，高1.35倍（95% CI 1.20-1.52; p<0.001）。FEV 1（800 ml）每减少一个标准差，死亡率的校正比值比增加2.11倍（95% CI 1.45-3.08; p<0.001）。FEV 1改善了EuroSCORE对死亡率的区分度。排除已知肺部疾病和/或肺量测定气流受限的人后，发现了类似的相关性。FEV 1降低强烈预测心脏手术后住院时间和住院死亡率增加。FEV 1是一种广泛可用的生理健康指标，可改善接受心脏手术的复杂患者的风险分层，应进行评估，以纳入新的预测工具。
An aging population and increasing use of percutaneous therapies have resulted in older patients with more co-morbidity being referred for cardiac surgery. Objective measurements of physiological reserve and severity of co-morbid disease are required to improve risk stratification. We hypothesised that FEV1 would predict mortality and length of stay following cardiac surgery. We assessed clinical outcomes in 2,241 consecutive patients undergoing coronary artery bypass grafting and/or valve surgery from 2001 to 2007 in a regional cardiac centre. Generalized linear models of the association between FEV1 and length of hospital stay and mortality were adjusted for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, long-term use of bronchodilators or steroids for lung disease, and type and urgency of surgery. FEV1 was compared to an established risk prediction model, the EuroSCORE. Spirometry was performed in 2,082 patients (93%) whose mean (SD) age was 67 (10) years. Median hospital stay was 3 days longer in patients in the lowest compared to the highest quintile for FEV1, 1.35-fold higher (95% CI 1.20–1.52; p<0.001). The adjusted odds ratio for mortality was increased 2.11-fold (95% CI 1.45–3.08; p<0.001) per standard deviation decrement in FEV1 (800 ml). FEV1 improved discrimination of the EuroSCORE for mortality. Similar associations were found after excluding people with known pulmonary disease and/or airflow limitation on spirometry. Reduced FEV1 strongly predicted increased length of stay and in-hospital mortality following cardiac surgery. FEV1 is a widely available measure of physiological health that may improve risk stratification of complex patients undergoing cardiac surgery and should be evaluated for inclusion in new prediction tools.
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