Ambler Gareth, Omar Rumana Z, Royston Patrick, Kinsman Robin, Keogh Bruce E, Taylor Kenneth M
Department of Statistical Science, University College, London, UK.
Circulation. 2005 Jul 12;112(2):224-31. doi: 10.1161/CIRCULATIONAHA.104.515049. Epub 2005 Jul 5.
Heart valve surgery has an associated in-hospital mortality rate of 4% to 8%. This study aims to develop a simple risk model to predict the risk of in-hospital mortality for patients undergoing heart valve surgery to provide information to patients and clinicians and to facilitate institutional comparisons.
Data on 32,839 patients were obtained from the Society of Cardiothoracic Surgeons of Great Britain and Ireland on patients who underwent heart valve surgery between April 1995 and March 2003. Data from the first 5 years (n=16,679) were used to develop the model; its performance was evaluated on the remaining data (n=16,160). The risk model presented here is based on the combined data. The overall in-hospital mortality was 6.4%. The risk model included, in order of importance (all P<0.01), operative priority, age, renal failure, operation sequence, ejection fraction, concomitant tricuspid valve surgery, type of valve operation, concomitant CABG surgery, body mass index, preoperative arrhythmias, diabetes, gender, and hypertension. The risk model exhibited good predictive ability (Hosmer-Lemeshow test, P=0.78) and discriminated between high- and low-risk patients reasonably well (receiver-operating characteristics curve area, 0.77).
This is the first risk model that predicts in-hospital mortality for aortic and/or mitral heart valve patients with or without concomitant CABG. Based on a large national database of heart valve patients, this model has been evaluated successfully on patients who had valve surgery during a subsequent time period. It is simple to use, includes routinely collected variables, and provides a useful tool for patient advice and institutional comparisons.
心脏瓣膜手术的院内死亡率为4%至8%。本研究旨在开发一种简单的风险模型，以预测接受心脏瓣膜手术患者的院内死亡风险，为患者和临床医生提供信息，并便于机构间比较。
从大不列颠及爱尔兰心胸外科医师协会获取了1995年4月至2003年3月期间接受心脏瓣膜手术患者的32839例数据。前5年的数据（n = 16679）用于构建模型；其性能在其余数据（n = 16160）上进行评估。此处呈现的风险模型基于合并后的数据。总体院内死亡率为6.4%。风险模型按重要性顺序包括（所有P<0.01）：手术优先级、年龄、肾衰竭、手术顺序、射血分数、同期三尖瓣手术、瓣膜手术类型、同期冠状动脉旁路移植术（CABG）手术、体重指数、术前心律失常、糖尿病、性别和高血压。该风险模型具有良好的预测能力（Hosmer-Lemeshow检验，P = 0.78），并且能较好地区分高风险和低风险患者（受试者操作特征曲线面积，0.77）。
这是首个预测有或无同期CABG的主动脉和/或二尖瓣心脏瓣膜患者院内死亡率的风险模型。基于一个大型的全国心脏瓣膜病患者数据库，该模型已在随后一段时间内接受瓣膜手术的患者中成功评估。它使用简单，包含常规收集的变量，为患者咨询和机构间比较提供了一个有用的工具。
