Carvalho Márcio Roberto Moraes de, Souza e Silva Nelson Albuquerque de, Klein Carlos Henrique, Oliveira Gláucia Maria Moraes de
Federal University of Rio de Janeiro.
Rev Bras Cir Cardiovasc. 2010 Apr-Jun;25(2):209-17. doi: 10.1590/s0102-76382010000200013.
Risk stratification models are used to assess the risk of death in surgery.
To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003.
Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve.
546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%- 10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62.
The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.
风险分层模型用于评估手术中的死亡风险。
对1999年至2003年12月在里约热内卢市四家公立医院接受冠状动脉旁路移植术（CABG）的2692例患者应用欧洲心脏手术风险评估系统逻辑模型（ES）进行批判性分析。
在里约热内卢市的四家公立医院随机抽取150份存活和死亡患者的病历样本。使用逻辑模型应用ES。比较观察到的致死率和模型预测的致死率。通过ROC曲线下面积估计鉴别能力的测量值。
在所选的600份病历中找到了546份。注意到巴西和欧洲人群中危险因素的患病率存在显著差异。预测的致死率为3.62%（95%CI：3.47-3.78），而估计的观察到的致死率为12.22%（95%CI：10.99-13.46）。在所有风险范围内，预测的致死率均被低估，预测率与观察率之间存在显著差异。ROC曲线下面积估计为0.62。
构成ES的危险因素患病率的差异，加上其低鉴别能力，阻碍了在巴西未经必要调整就推荐使用该模型。
