Modeli za stratifikaciju operativnog rizika u kardiohirurgiji: kategorizacija grupa rizika za EuroSCORE II model

  • Duško Nežić “Dedinje” Cardiovascular Institute, Clinic of Cardiac Surgery, Belgrade, Serbia
  • Miroslav Miličić “Dedinje” Cardiovascular Institute, Clinic of Cardiac Surgery, Belgrade, Serbia
  • Ivana Petrović “Dedinje” Cardiovascular Institute, Clinic of Cardiac Surgery, Belgrade, Serbia
  • Petrović Košević “Dedinje” Cardiovascular Institute, Clinic of Cardiac Surgery, Belgrade, Serbia
  • Slobodan Mićović “Dedinje” Cardiovascular Institute, Clinic of Cardiac Surgery, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180516124N
Ključne reči: hirurgija, kardijalna, procedure, mortalitet, bolnički, faktori rizika, rizik, procena, evropa

Sažetak


Uvod/Cilj. Granične vrednosti evropskog sistema za eva­lu­aciju operativnog rizika u kardiohirurgiji (EuroSCORE II) koje definišu grupe rizika (niska, umerena, visoka) nisu trenutno uniformno određene u literaturi. Cilj naše studije bio je da se predloži kategorizacija grupa rizika u EuroSCORE II modelu. Metode. Preoperativno je kod 7 641 uzastopnih bo­lesnika procenjen preoperativni rizik upotrebom EuroSCORE II. Primarni cilj studije bio je određivanje bolesničkog mo­rta­liteta prema pripadnosti određenoj kategoriji grupe rizika. Bolesnici sa vrednostima EuroSCORE II ≤ 2,50, > 2,50–6,50% i > 6,50% smešteni su u kategoriju niskog, umerenog ili visokog perioperativnog rizika, respektivno. Diskrimina­ciona snaga modela testirana je izračunavanjem površine ispod the receiver operating characteristic (ROC) krive (AUC). Kalibracija modela je bila procenjena upotrebom Hosmer-Lemeshow testa, kao i sa odnosom između zabeleženog i očekivanog (O/E) mortaliteta. Rezultati. Zabeleženi bol­nički mortalitet u našem uzorku je bio 3.86% (295 od 7 641 bolesnika). Diskriminatorna snaga EuroSCORE II je bila prihvatljiva za grupu niskog i visokog operativnog rizika (AUCs > 0,70), dok dobra diskriminacija nije potvrđena u grupi umerenog rizika. Hosmer-Lemeshow testom potvr­đena je dobra kalibracija u svim kategorijama grupa rizika. Odnos između zabeleženog i očekivanog (O/E) mortaliteta nije potvrdio dobru kalibraciju u grupi niskog i visokog rizika (blago, ali signifikantno potcenjivanje mortaliteta, O/E odnos od 1.24; 95% interval pouzdanosti 1,05–1,43), ali je potvrdio dobru kalibraciju u sve tri podkategorije grupe visokog operativnog rizika. Zaključak. Rezultati ove studije pokazuju prihvatljive sveukupne performance EuroSCORE II modela u smislu diskriminacije i tačnosti predviđanja perioperativnog mortaliteta u definisanim kategorijama grupa rizika. Potrebna je dodatna provera per­formansi EuroSCORE II u definisanim kategorijama grupa rizika zbog kontinuiranog poboljšanja stratifikacije rizika bolesnika pre planirane kardiohirurške intervencije.

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Objavljeno
2021/04/19
Broj časopisa
Vol. 77 Br. 6 (2020): Vojnosanit pregl
Rubrika
Originalni članak