Kliničke performanse modela za stratifikaciju operativnog rizika EuroSCORE II kod kardiohirurških bolesnika u Srbiji: studija provere na 10 048 bolesnika operisanih u jednom centru
Sažetak
Apstrakt
Uvod/Cilj. EuroSCORE II je razvijen nedavno sa idejom da se obezbedi bolja tačnost u predviđanju perioperativnog mortaliteta bolesnika podvrgnutih operacijama na otvorenom srcu. Cilj rada je bio da se provere kliničke performanse modela za stratifikaciju operativnog rizika u kardiohirurgiji – EuroSCORE II (Evropski sistem za procenu kadiohirurškog operativnog rizika) kod odraslih bolesnika u Srbiji kod kojih se izvode kardiohirurške procedure. Metode. Vrednosti EuroSCORE II za 10 048 uzastopno operisanih (od 1. januara 2012. do 31. marta 2017. godine) odraslih kardiohirurških bolesnika prospektivno su izračunate i unete u bazu podataka Instituta za kardiovaskularne bolesti “Dedinje” u Beogradu. Diskriminaciona snaga modela testirana je izračunavanjem površine ispod receiver operating characteristic (ROC) krive (AUC). Kalibracija modela je bila procenjena upotrebom Hosmer-Lemeshow (H-L) testa i odnosom između zabeleženog i očekivanog (O/E) mortaliteta. Bolesnici sa vrednostima EuroSCORE II od 0,5% do 2,5% definisani su kao bolesnici sa niskim operativnim rizikom, sa skorom preko 2.5% do 6.5 % sa umerenim, a preko 6,5% sa visokim operativnim rizikom. Rezultati. Zabeleženi bolnički mortalitet bio je 3,86% (388 od 10,048), a srednja vrednost mortaliteta predviđenog EuroSCORE-om II iznosila je 3.61%. Diskriminatorna snaga modela je bila vrlo dobra za ceo uzorak, kao i za sve podgrupe [koronarna, valvularna, kombinovana (koronarna plus valvularna) hirurgija, hirurgija grudne aorte i ostalo] izvedenih kardiohirurških procedura (sve AUCs > 0.75). H-L testom potvrđena je dobru kalibracija samo za kategoriju ‘druge procedure’. Primenom O/E odnosa potvrđena je dobra kalibracija za ceo uzorak [O/E odnos 1.07, 95% interval pouzdanosti (CI) 0.96–1.18], kao i za sve podgrupe izvedenih kardiohirurških procedura, osim značajnog potcenjivanja mortaliteta u hirurgiji grudne aorte (O/E odnos 1.64; 95% CI 1.31–1.97). EuroSCORE II precenio je operativni rizik u grupi niskog rizika, i potcenio operativni rizik u grupi viskog rizika (O/E odnos mortaliteta), sa prihvatljivom diskriminacijom za obe grupe (AUC = 0.72). Naprotiv, O/E odnos mortaliteta potvrdio je dobru kalibraciju za sve tri potkategorije grupe viskog operativnog rizika. Zaključak. Rezultati naše studije potvrđuju prihvatljive opšte performanse (diskriminaciju i kalibraciju) EuroSCORE II modela za stratifikaciju operativnog rizika u kardiohirurgiji, primenjenog na uzorak kardiohirurških bolesnika u Srbiji operisanih u našem Institutu, nakon uvođenja modela u upotrebu.
Reference
REFERENCES
Sullivan PG, Wallach JD, Ioannidis JP. Meta-Analysis Comparing Established Risk Prediction Models (EuroSCORE II, STS Score, and ACEF Score) for Perioperative Mortality During Cardiac Surgery. Am J Cardiol 2016; 118(10): 1574–82.
Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41(4): 734–44; discussion 744–5.
Barili F, Pacini D, Capo A, Rasovic O, Grossi C, Alamanni F, et al. Does EuroSCORE II perform better than its original ver-sions? A multicentre validation study. Eur Heart J 2013; 34(1): 22–9.
Mihajlovic B. Risk stratification and prediction of operative treat¬ment outcome in cardiosurgery. Med Pregl 2011; 64(3–4): 133–6.
Velicki L, Cemerlic-Adjic N, Pavlovic K, Mihajlovic BB, Bankovic D, Mihajlovic B, et al. Clinical performance of the EuroSCORE II compared with the previous EuroSCORE iterations. Thorac Cardiovasc Surg 2014; 62(4): 288–97.
Nezic D, Spasic T, Micovic S, Kosevic D, Petrovic I, Lausevic-Vuk L, et al. Consecutive Observational Study to Validate Euro-SCORE II Performances on a Single-Center, Contemporary Cardiac Surgical Cohort. J Cardiothorac Vasc Anesth 2016; 30(2): 345–51.
Noyez L, Kievit PC, Swieten HA, Boer MJ. Cardiac operative risk evaluation: The EuroSCORE II, does it make a real difference. Neth Heart J 2012; 20(12): 494–8.
Di Dedda U, Pelissero G, Agnelli B, De Vincentiis C, Castelvecchio S, Ranucci M. Accuracy, calibration and clinical performance of the new EuroSCORE II risk stratification system. Eur J Car-diothorac Surg 2013; 43(1): 27–32.
Nashef SA. Death and quality in cardiac surgery. J Patient Safety Risk Manag 2010; 16(4): 130–4.
Nezic D, Borzanovic M, Spasic T, Vukovic P. Calibration of the Eu¬roSCORE II risk stratification model: Is the Hosmer-Le-meshow test acceptable any more. Eur J Cardiothoracic Surg 2013; 43(1): 206.
Papadopoulos N, Wenzel R, Thudt M, Doss M, Wimmer-Greinecker G, Seeger F, et al. A Decade of Transapical Aortic Valve Im-plantation. Ann Thorac Surg 2016; 102(3): 759–65.
Ranucci M, Di Dedda U, Castelvecchio S, Menicanti L, Frigiola A, Pe¬lissero G. Surgical and Clinical Outcome Research (SCORE) group. Impact of preoperative anemia in outcome in adult car-diac surgery: A propensity-matched analysis. Ann Thorac Surg 2012; 94(4): 1134–42.
Scrascia G, Guida P, Caparrotti SM, Capone G, Contini M, Cassese M, et al. Incremental value of anemia in cardiac surgical risk prediction with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II model. Ann Thorac Surg 2014; 98(3): 869–75.
Hsieh WC, Chen PC, Corciova F, Tinica G. Liver dysfunction as an important predicting risk factor in patients undergoing car-diac surgery: A systematic review and meta-analysis. Int J Clin Exp Med 2015; 8(11): 20712–21.
Diaz GC, Renz JF. Cardiac surgery in patients with end-stage liver disease. J Cardiothorac Vasc Anesth 2014; 28(1): 155–62.
Abdullahi YS, Athanasopoulos LV, Casula RP, Moscarelli M, Bag-nall M, Ashrafian H, et al. Systematic review on the predictive ability of frailty assessment measures in cardiac surgery. Inter-act Cardiovasc Thorac Surg 2017; 24(4): 619–24.
Sündermann SH, Dademasch A, Seifert B, Rodriguez CB, Emmert MY, Walther T, et al. Frailty is a predictor of short- and mid-term mortality after elective cardiac surgery independently of age. Interact Cardiovasc Thorac Surg 2014; 18(5): 580–5.
Kunt AG, Kurtcephe M, Hidiroglu M, Cetin L, Kucuker A, Bakuy V, et al. Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort. In-teract Cardiovasc Thorac Surg 2013; 16(5): 625–9.
Sharples LD, Nashef SA. EuroSCORE Project Group. Reply to Nezic et al. Eur J Cardiothorac Surg 2013; 43: 207.
Grant SW, Hickey GL, Dimarakis I, Trivedi U, Bryan A, Treasure T, et al. How does EuroSCORE II perform in UK cardiac surgery; an analysis of 23 740 patients from the Society for Cardiothoracic Surgery in Great Britain and Ireland National Database. Heart 2012; 98(21): 1568–72.
Garcia-Valentin A, Mestres C, Bernabeu E, Bahamonde JA, Martín I, Rueda C, et al. Validation and quality measurements for Eu¬roSCORE and EuroSCORE II in the Spanish cardiac surgical population: A prospective, multicentre study. Eur J Cardiotho¬racic Surg 2016; 49: 399–405.
Guida P, Mastro F, Scrascia G, Whitlock R, Paparella D. Perform¬ance of the European System for Cardiac Operative Risk Evaluation II: A meta-analysis of 22 studies involving 145,592 cardiac surgery procedures. J Thorac Cardiovasc Surg 2014; 148(6): 3049–57.e1.
Paul P, Pennell ML, Lemeshow S. Standardizing the power of the Hosmer: Lemeshow goodness of fit test in large data sets. Stat Med 2013; 32(1): 67–80.
Chalmers J, Pullan M, Fabri B, Mcshane J, Shaw M, Mediratta N, et al. Validation of EuroSCORE II in a modern cohort of pa-tients undergoing cardiac surgery. Eur J Cardithorac Surg 2013; 43: 688–94.
Nishida T, Sonoda H, Oishi Y, Tanoue Y, Nakashima A, Shiokawa Y, et al. The novel EuroSCORE II algorithm predicts the hos-pital mortality of thoracic aorta surgery in 461 consecutive Japanese patients better than both the original additive and lo-gistic EuroSCORE algorithms. Interact Cardiovasc Thorac Surg 2014; 14: 446–50.
Siregar S, Groenwold RH, de Heer F, Bots ML, van der Graaf Y, van Herwerden LA. Performance of the original EuroSCORE. Eur J Cardiothorac Surg 2012; 41(4): 746–54.
Ranucci M, Castelvecchio S, Menicanti LA, Scolletta S, Biagioli B, Gio¬marelli P. An adjusted EuroSCORE model for high-risk cardiac patients. Eur J Cardiothorac Surg 2009; 36(5): 791–7.
Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Egge-brecht H, et al. ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic dis-eases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the Eu-ropean Society of Cardiology (ESC). Eur Heart J 2014; 35(41): 2873–926.
Berretta P, Patel HJ, Gleason TG, Sundt TM, Myrmel T, Desai N, et al. IRAD experience on surgical type A acute dissection pa-tients: Results and predictors of mortality. Ann Cardiothorac Surg 2016; 5(4): 346–51.
Rampoldi V, Trimarchi S, Eagle KA, Nienaber CA, Oh JK, Bossone E, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: The International Registry of Acute Aortic Dissection score. Ann Thorac Surg 2007; 83(1): 55–61.
Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangel¬ista A, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the Interna-tional Registry of Acute Aortic Dissection. J Am Coll Cardiol 2015; 66(4): 350–8.
Conzelmann LO, Weigang E, Mehlhorn U, Abugameh A, Hoffmann I, Blettner M, et al. Mortality in patients with acute aortic dis-section type A: Analysis of pre - and intraoperative risk factors from the German Registry for Acute Aortic Dissection type A (GERAADA). Eur J Cardiothorac Surg 2016; 49(2): e44–52.
Osnabrugge RL, Speir AM, Head SJ, Fonner CE, Fonner E, Kap-petein PA, et al. Performance of EuroSCORE II in a large US database: Implications for transcatheter aortic valve implanta-tion. Eur J Cardiothorac Surg 2014; 46(3): 400–8.
Arnáiz-García ME, González-Santos JM, López-Rodríguez J, Dal-mau-Sorlí MJ, Bueno-Codoñer M, Arévalo-Abascal A. Survival after major cardiac surgery: Performance and comparison of pre¬dictive ability of EuroSCORE II and logistic EuroSCORE in a sample of Mediterranean population. Thorac Cardiovasc Surg 2014; 62(4): 298–306; discussion 306–7.
Nezic D, Borzanovic M, Spasic T. The external validation of the EuroSCORE II risk stratification model. Eur J Cardiothorac Surg 2014; 45: 587.
Biancari F, Juvonen T, Onorati F, Faggian G, Heikkinen J, Airaksi-nen J, et al. Meta-analysis on the performance of the Euro-SCORE II and the Society of Thoracic Surgeons Scores in pa-tients undergoing aortic valve replacement. J Cardiothorac Vasc Anesth 2014; 28(6): 1533–9.
Chan V, Ahrari A, Ruel M, Elmistekawy E, Hynes M, Mesana TG. Perioperative deaths after mitral valve operations may be over¬estimated by contemporary risk models. Ann Thorac Surg 2014; 98(2): 605–10; discussion 610.
Nashef S, Sharples L. Pride without prejudice: EuroSCORE II, the STS score and the high-risk patient subset. Eur J Cardio-thorac Surg 2013; 44: 1012.
Collins GS, Le Manach Y, Numata S, Itatani K, Kanda K, Yaku H. Uninformative and misleading comparison of EuroSCORE and EuroSCORE II. Eur J Cardiothorac Surg 2017; 51(2): 399–400.
Howell NJ, Head SJ, Freemantle N, Meulen TA, Senanayake E, Menon A, et al. The new EuroSCORE II does not improve prediction of mortality in high-risk patients undergoing cardiac surgery: A collaborative analysis of two European centres. Eur J Cardiothorac Surg 2013; 44(6): 1006–11.
Bai Y, Wang L, Guo Z, Chen Q, Jiang N, Dai J, et al. Perform-ance of EuroSCORE II and SinoSCORE in Chinese patients undergoing coronary artery bypass grafting. Interact Cardio-vasc Thorac Surg 2016; 23(5): 733–9.