Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort A prospective, observational study
Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort A prospective, observational study
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DOI：
10.1097/eja.0000000000000223
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发表时间：
2015-07-01
影响因子：
3.6
通讯作者：
Ulke, Zerrin Sungur
中科院分区：
文献类型：
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作者：
Canet, Jaume;Sabate, Sergi;Ulke, Zerrin Sungur
背景术后呼吸衰竭（PRF）是手术后最常见的呼吸系统并发症。目的 本研究的目的是建立一个临床上有用的 PRF 发展预测模型。设计一项多中心队列的前瞻性观察研究。设置 欧洲各地 63 家医院。患者 在 7 天的招募期间在全身或局部麻醉下接受任何外科手术的患者。主要观察指标 手术后 5 天内 PRF 的发展。 PRF 的定义是动脉血氧分压 (PaO2) 低于 8 kPa，或通过脉搏血氧饱和度 (SpO(2)) 测量的新发氧合血红蛋白饱和度低于 90%，同时呼吸需要传统氧疗、无创或有创机械通气的室内空气。结果 224 名患者出现 PRF（所研究的 5384 名患者中的 4.2%）。发生 PRF 的患者的院内死亡率 [95% 置信区间 (95% CI)] 较高 [10.3%（6.3 至 14.3）vs. 0.4%（0.2 至 0.6）]。回归模型确定了预测性 PRF 评分，其中包括七个独立风险因素：术前 SpO(2) 低；至少一种术前呼吸道症状；术前慢性肝病；充血性心力衰竭病史；开放胸腔内或上腹部手术；外科手术持续至少2小时；和紧急手术。受试者工作特征曲线下面积（c 统计量）为 0.82（95% CI 0.79 至 0.85），Hosmer-Lemeshow 拟合优度统计量为 7.08（P = 0.253）。结论 基于七个客观、易于评估的因素的风险评分能够预测哪些患者会发生 PRF。该评分可能有助于术前风险评估和管理，并为测试干预措施以改善结果提供基础。该研究已在 ClinicalTrials.gov 上注册（标识符 NCT01346709）。
BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO(2)) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO(2); at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes. The study was registered at ClinicalTrials.gov (identifier NCT01346709).