Carnero-Alcázar Manuel, Silva Guisasola Jacobo Alberto, Reguillo Lacruz Fernando José, Maroto Castellanos Luis Carlos, Cobiella Carnicer Javier, Villagrán Medinilla Enrique, Tejerina Sánchez Teresa, Rodríguez Hernández José Enrique
Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
Interact Cardiovasc Thorac Surg. 2013 Mar;16(3):293-300. doi: 10.1093/icvts/ivs480. Epub 2012 Nov 23.
To compare and validate the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with EuroSCORE at our institution.
The logistic EuroSCORE and EuroSCORE II were calculated on the entire patient cohort undergoing major cardiac surgery at our centre between January 2005 and December 2010. The goodness of fit was compared by means of the Hosmer-Lemeshow (HL) chi-squared test and the area under the curve (AUC) of the receiver operating characteristic curves of both scales applied to the same sample of patients. These analyses were repeated and stratified by the type of surgery.
Mortality of 5.66% was observed, with estimated mortalities according to logistic EuroSCORE and EuroSCORE II of 9 and 4.46%, respectively. The AUC for EuroSCORE (0.82, 95% confidence interval [CI] 0.79-0.85) was lower than that for EuroSCORE II (0.85, 95% CI 0.83-0.87) without the differences being statistically significant (P = 0.056). Both scales showed a good discriminative capacity for all the pathologies subgroups. The two scales showed poor calibration in the sample: EuroSCORE (χ(2) = 39.3, P(HL) < 0.001) and EuroSCORE II (χ(2) = 86.69, P(HL) < 0.001). The calibration of EuroSCORE was poor in the groups of patients undergoing coronary (P(HL) = 0.01), valve (P(HL) = 0.01) and combined coronary valve surgery (P(HL) = 0.012); and that of EuroSCORE II in the group of coronary (P(HL) = 0.001) and valve surgery (P(HL) < 0.001) patients.
EuroSCORE II demonstrated good discriminative capacity and poor calibration in the patients undergoing major cardiac surgery at our centre.
在我们机构中比较并验证新的欧洲心脏手术风险评估系统（EuroSCORE）II与EuroSCORE。
对2005年1月至2010年12月期间在我们中心接受心脏大手术的所有患者队列计算逻辑EuroSCORE和EuroSCORE II。通过Hosmer-Lemeshow（HL）卡方检验以及应用于同一患者样本的两种量表的受试者工作特征曲线的曲线下面积（AUC）来比较拟合优度。这些分析按手术类型重复并分层。
观察到死亡率为5.66%，根据逻辑EuroSCORE和EuroSCORE II估计的死亡率分别为9%和4.46%。EuroSCORE的AUC（0.82，95%置信区间[CI] 0.79 - 0.85）低于EuroSCORE II的AUC（0.85，95% CI 0.83 - 0.87），差异无统计学意义（P = 0.056）。两种量表对所有病理亚组均显示出良好的鉴别能力。两种量表在样本中显示出校准不佳：EuroSCORE（χ(2) = 39.3，P(HL) < 0.001）和EuroSCORE II（χ(2) = 86.69，P(HL) < 0.001）。EuroSCORE在接受冠状动脉（P(HL) = 0.01）、瓣膜（P(HL) = 0.01）和冠状动脉瓣膜联合手术（P(HL) = 0.012）的患者组中校准不佳；EuroSCORE II在冠状动脉（P(HL) = 0.001）和瓣膜手术（P(HL) < 0.001）患者组中校准不佳。
在我们中心接受心脏大手术的患者中，EuroSCORE II显示出良好的鉴别能力，但校准不佳。
