Fibla Juan J, Brunelli Alessandro, Cassivi Stephen D, Deschamps Claude
Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Interact Cardiovasc Thorac Surg. 2012 Aug;15(2):276-9. doi: 10.1093/icvts/ivs174. Epub 2012 May 17.
In order to develop a practical risk score for 90-day mortality following surgical lung biopsy (SLB) for interstitial lung disease (ILD) we reviewed 311 consecutive patients undergoing SLB for ILD between 2002 and 2009. Postoperative complication, 30-day and 90-day mortality rates were 11.5%, 9% and 10.6% respectively. Univariable and multivariable analyses, validated by bootstrap statistics, were used to identify factors associated with 90-day mortality. A scoring system was developed by proportionally weighting the regression coefficients of the significant predictors of 90-day mortality: age >67 (P < 0.0001, weighted score 1.5), preoperative intensive care unit (ICU) admission (P = 0.006, weighted score 2), immunosuppressive treatment (P = 0.004, weighted score 1.5) and open surgery (P = 0.03, weighted score 1). Patients were grouped in four classes showing incremental risk of death at 90 days: class A, score 0 (2%); class B, score 1-2 (12%); class C, score 2.5-3 (40%); class D, score >3 (86%); P <0.0001). SLB entails a considerable surgical risk with an overall 90-day mortality around 10%. We were able to develop a practical risk score which, if validated by other independent studies, can be easily used to stratify the risk of SLB candidates and assess the cost-effectiveness of this procedure.
为了制定一个针对间质性肺疾病（ILD）患者进行外科肺活检（SLB）后90天死亡率的实用风险评分，我们回顾了2002年至2009年间连续接受SLB治疗的311例ILD患者。术后并发症、30天和90天死亡率分别为11.5%、9%和10.6%。采用单变量和多变量分析，并通过自抽样统计进行验证，以确定与90天死亡率相关的因素。通过按比例加权90天死亡率的显著预测因素的回归系数来制定评分系统：年龄>67岁（P<0.0001，加权分数1.5）、术前入住重症监护病房（ICU）（P = 0.006，加权分数2）、免疫抑制治疗（P = 0.004，加权分数1.5）和开放手术（P = 0.03，加权分数1）。患者被分为四类，显示出90天时死亡风险递增：A类，分数为0（2%）；B类，分数为1 - 2（12%）；C类，分数为2.5 - 3（40%）；D类，分数>3（86%）；P<0.0001）。SLB具有相当大的手术风险，总体90天死亡率约为10%。我们能够制定一个实用的风险评分，如果经其他独立研究验证，可轻松用于对SLB候选者的风险进行分层，并评估该手术的成本效益。
