Department of General Psychology, University of Padova, Padova, Italy.
Eur J Cardiothorac Surg. 2011 May;39(5):e102-6. doi: 10.1016/j.ejcts.2010.12.009. Epub 2011 Jan 26.
Several composite risk score indices, the most common being the Stroke Index and the European System for Cardiac Operative Risk Evaluation (EuroSCORE), have been developed to predict perioperative events such as cerebrovascular accidents or death. The main aim of the present study was to compare the preoperative associations between the Stroke Index or the EuroSCORE with anxiety, depression, memory, attention, and executive functions scores in patients undergoing cardiac surgery.
Ninety-one patients were required to perform a preoperative psychological evaluation. Trail Making Test A and B (TMT A/B), Memory with 10 and 30s interference, Digit Span Test, Phonemic Fluency, State and Trait Anxiety Inventory (STAI Y1/Y2), and Center for Epidemiological Study of Depression Scale (CES-D) were administered. The Stroke Index and the EuroSCORE were also considered for each patient. Correlations between the Stroke Index or the EuroSCORE, mood, and neuropsychological scores were performed.
Seventy-seven patients completed the psychological evaluation. The Stroke Index was significantly correlated with TMT A (ρ=0.40, p=0.001), TMT B (ρ=0.38, p=0.001), Memory with 10s (ρ=-0.34, p=0.003) and 30s (ρ=-0.40, p=0.001) interference, and Phonemic Fluency (ρ=-0.29, p=0.01), but not with Digit Span Test (ρ=-0.18, p=0.13), STAI Y1 (ρ=0.08, p=0.44), STAI Y2 (ρ=0.06, p=0.56), and CES-D (ρ=0.11, p=0.31) scores. The EuroSCORE was significantly correlated not only with TMT A (ρ=0.49, p=0.001), TMT B (ρ=0.42, p=0.001), Memory with 10s (ρ=-0.23, p=0.04) and 30s (ρ=-0.35, p=0.002) interference, Phonemic Fluency (ρ=-0.28, p=0.01), and Digit Span Test (ρ=-0.28, p=0.01) but also with STAI Y1 (ρ=0.27, p=0.02), STAI Y2 (ρ=0.23, p=0.04), and CES-D (ρ=0.26, p=0.02).
While both the Stroke Index and the EuroSCORE account for the relationship between biomedical and cognitive risk factors in predicting perioperative risk, only the EuroSCORE also accounts for affective dysfunctions, which, in turn, have been proved to represent risk factors for perioperative adverse events. Therefore, compared with the Stroke Index, the EuroSCORE can be considered a more complete risk index in predicting perioperative risk. Data also suggest that a comprehensive preoperative evaluation of biomedical, mood, and cognitive performances might provide a more accurate mirror of the actual risk in patients undergoing cardiac surgery.
为了预测围手术期事件，如脑血管意外或死亡，已经开发了几种复合风险评分指数，最常见的是卒中指数和欧洲心脏手术风险评估系统（EuroSCORE）。本研究的主要目的是比较接受心脏手术的患者术前卒中指数或 EuroSCORE 与焦虑、抑郁、记忆、注意力和执行功能评分之间的关联。
91 名患者需要进行术前心理评估。进行了连线测试 A 和 B（TMT A/B）、有 10 秒和 30 秒干扰的记忆测试、数字跨度测试、语音流畅性、状态和特质焦虑量表（STAI Y1/Y2）和流行病学研究中心抑郁量表（CES-D）。还为每位患者考虑了卒中指数和 EuroSCORE。对卒中指数或 EuroSCORE、情绪和神经心理学评分之间进行了相关性分析。
77 名患者完成了心理评估。卒中指数与 TMT A（ρ=0.40，p=0.001）、TMT B（ρ=0.38，p=0.001）、10 秒记忆（ρ=-0.34，p=0.003）和 30 秒记忆（ρ=-0.40，p=0.001）和语音流畅性（ρ=-0.29，p=0.01）显著相关，但与数字跨度测试（ρ=-0.18，p=0.13）、STAI Y1（ρ=0.08，p=0.44）、STAI Y2（ρ=0.06，p=0.56）和 CES-D（ρ=0.11，p=0.31）评分无关。EuroSCORE 不仅与 TMT A（ρ=0.49，p=0.001）、TMT B（ρ=0.42，p=0.001）、10 秒记忆（ρ=-0.23，p=0.04）和 30 秒记忆（ρ=-0.35，p=0.002）、语音流畅性（ρ=-0.28，p=0.01）和数字跨度测试（ρ=-0.28，p=0.01）显著相关，还与 STAI Y1（ρ=0.27，p=0.02）、STAI Y2（ρ=0.23，p=0.04）和 CES-D（ρ=0.26，p=0.02）显著相关。
虽然卒中指数和 EuroSCORE 都考虑了生物医学和认知风险因素之间的关系，以预测围手术期风险，但只有 EuroSCORE 还考虑了情感障碍，而情感障碍已被证明是围手术期不良事件的风险因素。因此，与卒中指数相比，EuroSCORE 可以被认为是预测围手术期风险的更完整的风险指数。数据还表明，对生物医学、情绪和认知表现进行全面的术前评估，可能会更准确地反映心脏手术患者的实际风险。
