Hoeks Sanne E, op Reimer Wilma J M Scholte, van Gestel Yvette R B M, Smolderen Kim G, Verhagen Hence, van Domburg Ron T, van Urk Hero, Poldermans Don
Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Am J Med. 2009 Jun;122(6):559-65. doi: 10.1016/j.amjmed.2008.10.041. Epub 2009 Apr 18.
Peripheral arterial disease patients undergoing vascular surgery are known to be at risk for the occurrence of (late) cardiovascular events. Before surgery, the perioperative cardiac risk is commonly assessed using the Lee Risk Index score, a combination of 6 cardiac risk factors. This study assessed the predictive value of the Lee Risk Index for late mortality and long-term health status in patients after vascular surgery.
Between May and December 2004, data on 711 consecutive peripheral arterial disease patients undergoing vascular surgery were collected from 11 hospitals in the Netherlands. Before surgery, the Lee Risk Index was assessed in all patients. At 3-year follow-up, 149 patients died (21%) and the disease-specific Peripheral Artery Questionnaire (PAQ) was completed in 84% (n=465) of the survivors. Impaired health status according to the PAQ was defined by the lowest tertile of the PAQ summary score. Multivariable regression analyses were performed to investigate the prognostic ability of the Lee Index for mortality and impaired health status at 3-year follow-up.
The Lee Risk Index proved to be an independent prognostic factor for both late mortality (1 risk factor hazard ratio (HR)=2.1; 95% confidence interval [CI], 1.2-3.6; 2 risk factors HR=2.4; 95% CI, 1.4-4.0 and >or=3 risk factors HR=3.2; 95% CI, 1.7-6.2) and impaired health status at 3-year follow-up (1 risk factor odds ratio [OR]=2.0; 95% CI, 1.1-3.5; 2 risk factors OR=2.9; 95% CI, 1.6-5.2 and >or=3 risk factors OR=3.2; 95% CI, 1.3-7.5). The predominant contributing factors associated with late mortality were cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency. For impaired health status, ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency were the prognostic factors.
The preoperative Lee Risk Index is not only an important prognostic factor for in-hospital outcome but also for late mortality and impaired health status in patients with peripheral arterial disease.
已知接受血管手术的外周动脉疾病患者有发生（晚期）心血管事件的风险。手术前，通常使用Lee风险指数评分来评估围手术期心脏风险，该评分综合了6个心脏风险因素。本研究评估了Lee风险指数对外周动脉疾病患者术后晚期死亡率和长期健康状况的预测价值。
2004年5月至12月期间，从荷兰11家医院收集了711例连续接受血管手术的外周动脉疾病患者的数据。手术前，对所有患者进行Lee风险指数评估。在3年随访时，149例患者死亡（21%），84%（n = 465）的幸存者完成了疾病特异性外周动脉问卷（PAQ）。根据PAQ定义的健康状况受损为PAQ总分最低三分位数。进行多变量回归分析以研究Lee指数对3年随访时死亡率和健康状况受损的预后能力。
Lee风险指数被证明是晚期死亡率（1个风险因素风险比（HR）= 2.1；95%置信区间[CI]，1.2 - 3.6；2个风险因素HR = 2.4；95% CI，1.4 - 4.0；≥3个风险因素HR = 3.2；95% CI，1.7 - 6.2）和3年随访时健康状况受损（1个风险因素比值比[OR] = 2.0；95% CI，1.1 - 3.5；2个风险因素OR = 2.9；95% CI，1.6 - 5.2；≥3个风险因素OR = 3.2；95% CI，1.3 - 7.5）的独立预后因素。与晚期死亡率相关的主要因素是脑血管疾病、胰岛素依赖型糖尿病和肾功能不全。对于健康状况受损，缺血性心脏病、心力衰竭、脑血管疾病、胰岛素依赖型糖尿病和肾功能不全是预后因素。
术前Lee风险指数不仅是外周动脉疾病患者住院结局的重要预后因素，也是晚期死亡率和健康状况受损的重要预后因素。
