Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, People's Republic of China.
Heart Lung Circ. 2013 Aug;22(8):606-11. doi: 10.1016/j.hlc.2012.12.012. Epub 2013 Feb 1.
To assess the performance of the The European System for Cardiac Operative. Risk Evaluation II (EuroSCORE II) in Chinese patients undergoing heart valve surgery at our centre.
From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the original EuroSCORE and EuroSCORE II models. All patients were divided into single valve surgery and multiple valve surgery subgroups. The entire cohort and each subgroup were analysed. Calibration of the original EuroSCORE and EuroSCORE II models was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.
Observed mortality was 3.32% overall, compared to expected mortality 3.84% for the original additive EuroSCORE (H-L: P = 0.013), 3.33% for the original logistic EuroSCORE (H-L: P = 0.08), and 2.52% for the EuroSCORE II (H-L: P < 0.0001). The EuroSCORE II model showed good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H-L: P = 0.103) and poor calibration for patients undergoing multiple valve surgery (H-L: P < 0.0001). The discriminative power of the original EuroSCORE model (area under the ROC curve of 0.684 and 0.673 for the additive and logistic model, respectively) and EuroSCORE II model (area under the ROC curve of 0.685) for the entire cohort was poor. The discriminative power of the EuroSCORE II model was good for the single valve surgery group (area under the ROC curve of 0.792) and was poor for the multiple valve surgery group (area under the ROC curve of 0.605).
The EuroSCORE II model gives an accurate prediction for individual operative risk in patients undergoing single valve surgery but an imprecise prediction in patients undergoing multiple valve surgery at our centre. Therefore, the use of the EuroSCORE II model for risk evaluation may be suitable in patients undergoing single valve surgery, and the creation of a new model which accurately predicts outcomes in patients undergoing multiple valve surgery is possibly required at our centre in the future.
评估欧洲心脏手术风险评估系统 II （EuroSCORE II）在我院行心脏瓣膜手术的中国患者中的表现。
2006 年 1 月至 2011 年 12 月，我院连续收治 3479 例心脏瓣膜手术患者，按原始 EuroSCORE 和 EuroSCORE II 模型进行评分。所有患者均分为单瓣膜手术和多瓣膜手术亚组。对整个队列和每个亚组进行分析。采用 Hosmer-Lemeshow（H-L）检验评估原始 EuroSCORE 和 EuroSCORE II 模型的校准情况。通过计算受试者工作特征（ROC）曲线下面积评估区分度。
全组观察死亡率为 3.32%，与原始加性 EuroSCORE 的预期死亡率 3.84%（H-L：P = 0.013）、原始逻辑 EuroSCORE（H-L：P = 0.08）和 EuroSCORE II（H-L：P < 0.0001）相比。EuroSCORE II 模型在预测单瓣膜手术患者院内死亡率方面具有良好的校准（H-L：P = 0.103），但在预测多瓣膜手术患者时校准效果较差（H-L：P < 0.0001）。原始 EuroSCORE 模型（加性和逻辑模型的 ROC 曲线下面积分别为 0.684 和 0.673）和 EuroSCORE II 模型（ROC 曲线下面积为 0.685）对整个队列的区分能力均较差。EuroSCORE II 模型在单瓣膜手术组具有良好的区分能力（ROC 曲线下面积为 0.792），而在多瓣膜手术组区分能力较差（ROC 曲线下面积为 0.605）。
在我院行单瓣膜手术的患者中，EuroSCORE II 模型能准确预测个体手术风险，但在多瓣膜手术患者中预测结果不精确。因此，在我院，EuroSCORE II 模型可能适用于单瓣膜手术患者的风险评估，而需要建立一个新的模型来准确预测多瓣膜手术患者的结局。
