| 摘要: |
| 目的 评价第2版欧洲心脏手术危险评估系统(EuroSCORE Ⅱ)模型对本中心瓣膜手术患者在院死亡率预测的准确性。方法 回顾性收集2006年1月至2011年12月因瓣膜疾病在本中心行外科治疗的3 479例患者的临床资料,按第1版的EuroSCORE (additive EuroSCORE、logistic EuroSCORE)模型和EuroSCORE Ⅱ模型模给予评分,并对患者的实际死亡率与预测死亡率进行对比。模型预测的符合程度应用H-L χ2检验,而预测的鉴别效度则通过ROC曲线下面积反映。结果 3 479例患者在院死亡112例,全组实际在院死亡率为3.2%。Additive EuroSCORE、logistic EuroSCORE及EuroSCORE Ⅱ模型预测的在院死亡率分别为3.8%、3.3%和2.5%,其中logistic EuroSCORE对全组患者在院死亡的预测符合程度较高(P=0.08),而additive EuroSCORE高估了实际在院死亡率 (P=0.013), EuroSCORE Ⅱ则低估了实际在院死亡率 (P<0.000 1)。EuroSCORE Ⅱ模型对单瓣膜手术患者在院死亡预测具有较好的准确性(P=0.103,ROC曲线下面积为0.792),而对多瓣膜手术组患者的预测准确性则较差(P<0.000 1,ROC曲线下面积为0.605)。Additive EuroSCORE、logistic EuroSCORE及EuroSCORE Ⅱ模型对全组患者在院死亡预测的鉴别效度均较差(ROC曲线下面积分别为0.684、0.673和0.685)。结论 EuroSCORE Ⅱ模型对本中心单瓣膜手术患者死亡风险预测的准确性较好,但对多瓣膜手术患者死亡风险预测的准确性较差,不适合多瓣膜手术患者的在院死亡风险预测,在临床实践中应慎重考虑。 |
| 关键词: 心脏瓣膜疾病 心脏外科手术 EuroSCORE Ⅱ 医院死亡率 |
| DOI：10.3724/SP.J.1008.2013.00536 |
| 投稿时间：2012-12-19修订日期：2013-03-13 |
| 基金项目:卫生公益性行业科研专项基金(200802096). |
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| Validation of EuroSCORE Ⅱ in predicating in-hospital mortality among Chinese patients undergoing heart valve surgery |
| JIN Lei,WANG Chong,LI Bai-ling,LANG Xi-long,HAN Lin,XU Zhi-yun* |
(Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To assess the performance of the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ) in predicating in-hospital mortality among Chinese patients undergoing heart valve surgery at our center. Methods From January 2006 to December 2011, 3 479 consecutive patients who underwent heart valve surgery at our center were enrolled in this study and they were scored by the original EuroSCORE(addtive EuroSCORE and logistic EuroSCORE) and EuroSCORE Ⅱ model. The actual mortality rate of patients was compared with those of the predicted ones. The performances of the original EuroSCORE and EuroSCORE Ⅱ model were assessed by the Hosmer-Lemeshow (H-L) test. The discrimination validity of prediction was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results There were 112 in-hospital deaths among the 3 479 patients, with an in-hospital mortality rate of 3.2%, compared to the predicted mortality rates of 3.84% by the additive EuroSCORE (H-L: P=0.013, suggesting a higher prediction) ,3.33% by the logistic EuroSCORE (H-L: P=0.08, suggesting good consistency), and 2.52% by the EuroSCORE Ⅱ (H-L: P<0.0001, suggesting a lower prediction).EuroSCORE Ⅱ showed a good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H-L: P=0.103, area under the ROC curve of 0.792) and a poor calibration for patients undergoing multiple valve surgery (H-L: P<0.0001, area under the ROC curve of 0.605). The discriminative powers of the predictions by additive EuroSCORE, logistic EuroSCORE, and EuroSCORE Ⅱ were poor for the entire cohort, with the areas under the ROC curve being 0.684, 0.673, and 0.685, respectively.Conclusion EuroSCORE Ⅱ has a better accuracy for predicting mortality of patients undergoing single valve surgery, but not for those undergoing multiple valve surgery, which should be considered in clinical practice. |
| Key words: heart valve diseases cardiac surgical procedures EuroSCORE Ⅱ hospital mortality |
