PDF(Pubmed)
Abstract：
UNASSIGNED: Heart failure (HF) is one of the most important indications of the severity of valvular heart disease (VHD). VHD with HF is frequently associated with a higher surgical risk. Our study sought to develop a risk score model to predict the postoperative mortality of suspected HF patients after valvular surgery.
UNASSIGNED: Between January 2016 and December 2018, all consecutive adult patients suspected of HF and undergoing valvular surgery in the Chinese Cardiac Surgery Registry (CCSR) database were included. Finally, 14,645 patients (55.39 ± 11.6 years, 43.5% female) were identified for analysis. As a training group for model derivation, we used patients who had surgery between January 2016 and May 2018 (11,292 in total). To validate the model, patients who underwent surgery between June 2018 and December 2018 (a total of 3353 patients) were included as a testing group. In training group, we constructed and validated a scoring system to predict postoperative mortality using multivariable logistic regression and bootstrapping method (1000 re-samples). We validated the scoring model in the testing group. Brier score and calibration curves using bootstrapping with 1000 re-samples were used to evaluate the calibration. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the discrimination. The results were also compared to EuroSCORE II.
UNASSIGNED: The final score ranged from 0 to 19 points and involved 9 predictors: age ≥ 60 years; New York Heart Association Class (NYHA) IV; left ventricular ejection fraction (LVEF) < 35%; estimated glomerular filtration rate (eGFR) < 50 mL/min/1.73 m 2 ; preoperative dialysis; Left main artery stenosis; non-elective surgery; cardiopulmonary bypass (CPB) time > 200 minutes and perioperative transfusion. In training group, observed and predicted postoperative mortality rates increased from 0% to 45.5% and from 0.8% to 50.3%, respectively, as the score increased from 0 up to ≥ 10 points. The scoring model\'s Brier scores in the training and testing groups were 0.0279 and 0.0318, respectively. The area under the curve (AUC) values of the scoring model in both the training and testing groups were 0.776, which was significantly higher than EuroSCORE II in both the training (AUC = 0.721, Delong test, p < 0.001) and testing (AUC = 0.669, Delong test, p < 0.001) groups.
UNASSIGNED: The new risk score is an effective and concise tool that could accurately predict postoperative mortality rates in suspected HF patients after valve surgery.
UNASSIGNED: Between January 2016 and December 2018, all consecutive adult patients suspected of HF and undergoing valvular surgery in the Chinese Cardiac Surgery Registry (CCSR) database were included. Finally, 14,645 patients (55.39 ± 11.6 years, 43.5% female) were identified for analysis. As a training group for model derivation, we used patients who had surgery between January 2016 and May 2018 (11,292 in total). To validate the model, patients who underwent surgery between June 2018 and December 2018 (a total of 3353 patients) were included as a testing group. In training group, we constructed and validated a scoring system to predict postoperative mortality using multivariable logistic regression and bootstrapping method (1000 re-samples). We validated the scoring model in the testing group. Brier score and calibration curves using bootstrapping with 1000 re-samples were used to evaluate the calibration. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the discrimination. The results were also compared to EuroSCORE II.
UNASSIGNED: The final score ranged from 0 to 19 points and involved 9 predictors: age ≥ 60 years; New York Heart Association Class (NYHA) IV; left ventricular ejection fraction (LVEF) < 35%; estimated glomerular filtration rate (eGFR) < 50 mL/min/1.73 m 2 ; preoperative dialysis; Left main artery stenosis; non-elective surgery; cardiopulmonary bypass (CPB) time > 200 minutes and perioperative transfusion. In training group, observed and predicted postoperative mortality rates increased from 0% to 45.5% and from 0.8% to 50.3%, respectively, as the score increased from 0 up to ≥ 10 points. The scoring model\'s Brier scores in the training and testing groups were 0.0279 and 0.0318, respectively. The area under the curve (AUC) values of the scoring model in both the training and testing groups were 0.776, which was significantly higher than EuroSCORE II in both the training (AUC = 0.721, Delong test, p < 0.001) and testing (AUC = 0.669, Delong test, p < 0.001) groups.
UNASSIGNED: The new risk score is an effective and concise tool that could accurately predict postoperative mortality rates in suspected HF patients after valve surgery.
摘要：
■心力衰竭（HF）是瓣膜性心脏病（VHD）严重程度的最重要指征之一。伴有HF的VHD通常与较高的手术风险相关。我们的研究试图建立一个风险评分模型来预测瓣膜手术后疑似HF患者的术后死亡率。
■在2016年1月至2018年12月期间，中国心脏外科注册中心（CCSR）数据库中所有疑似HF并接受瓣膜手术的连续成年患者均被纳入。最后,14645例（55.39±11.6岁，43.5％的女性）进行分析。作为模型推导的训练组，我们使用了2016年1月至2018年5月期间接受手术的患者(共11,292例).要验证模型，纳入2018年6月至2018年12月期间接受手术的患者(共3,353例患者)作为试验组.在训练组中,我们构建并验证了使用多变量逻辑回归和自举方法(1000个重新样本)预测术后死亡率的评分系统.我们在测试组中验证了评分模型。使用具有1000个重新样品的自举的Brier评分和校准曲线来评估校准。使用受试者工作特征曲线下面积(AUROC)来评价鉴别。结果也与EuroSCOREII进行了比较。
■最终评分为0至19分，涉及9个预测因素：年龄≥60岁；纽约心脏协会（NYHA）IV级；左心室射血分数（LVEF）<35％；估计肾小球滤过率（eGFR）<50mL/min/1.73m2；术前透析；左主干狭窄；非选择性手术；围手术期体外循环（CPB）时间>200分钟在训练组中,观察和预测的术后死亡率从0％增加到45.5％，从0.8％增加到50.3％，分别,随着分数从0增加到≥10分。训练组和测试组的评分模型Brier得分分别为0.0279和0.0318。训练组和测试组评分模型的曲线下面积(AUC)均为0.776,均显著高于EuroSCOREⅡ(AUC=0.721,Delong检验,p<0.001)和测试(AUC=0.669，德隆测试，p<0.001)组。
■新的风险评分是一种有效且简洁的工具，可以准确预测瓣膜手术后疑似HF患者的术后死亡率。
■在2016年1月至2018年12月期间，中国心脏外科注册中心（CCSR）数据库中所有疑似HF并接受瓣膜手术的连续成年患者均被纳入。最后,14645例（55.39±11.6岁，43.5％的女性）进行分析。作为模型推导的训练组，我们使用了2016年1月至2018年5月期间接受手术的患者(共11,292例).要验证模型，纳入2018年6月至2018年12月期间接受手术的患者(共3,353例患者)作为试验组.在训练组中,我们构建并验证了使用多变量逻辑回归和自举方法(1000个重新样本)预测术后死亡率的评分系统.我们在测试组中验证了评分模型。使用具有1000个重新样品的自举的Brier评分和校准曲线来评估校准。使用受试者工作特征曲线下面积(AUROC)来评价鉴别。结果也与EuroSCOREII进行了比较。
■最终评分为0至19分，涉及9个预测因素：年龄≥60岁；纽约心脏协会（NYHA）IV级；左心室射血分数（LVEF）<35％；估计肾小球滤过率（eGFR）<50mL/min/1.73m2；术前透析；左主干狭窄；非选择性手术；围手术期体外循环（CPB）时间>200分钟在训练组中,观察和预测的术后死亡率从0％增加到45.5％，从0.8％增加到50.3％，分别,随着分数从0增加到≥10分。训练组和测试组的评分模型Brier得分分别为0.0279和0.0318。训练组和测试组评分模型的曲线下面积(AUC)均为0.776,均显著高于EuroSCOREⅡ(AUC=0.721,Delong检验,p<0.001)和测试(AUC=0.669，德隆测试，p<0.001)组。
■新的风险评分是一种有效且简洁的工具，可以准确预测瓣膜手术后疑似HF患者的术后死亡率。
