术后肺部并发症预测评分的前瞻性外部验证。

Prospective external validation of a predictive score for postoperative pulmonary complications.

机构信息

From the Department of Anesthesiology (V.M.) and Department of Anesthesiology and Postoperative Care Unit (J.C.), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Anesthesiology, Fundació, Puigvert, Barcelona, Spain (S.S.); Department of Anesthesiology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain (L.G.); Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (M.G.d.A.); Department of Anesthesia and Critical Care, Hospital Clínico Universitario, University of Valencia, Valencia, Spain (J.B.); Department of Anesthesiology and Critical Care, Université Pierre et Marie Curie-Paris VI, CHU Pitié-Salpêtrière, Paris, France (O.L.); Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany (A.H.); and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital-IST, University of Genoa, Genoa, Italy (P.P.).

出版信息

Anesthesiology. 2014 Aug;121(2):219-31. doi: 10.1097/ALN.0000000000000334.

DOI:10.1097/ALN.0000000000000334

PMID:24901240

Abstract

BACKGROUND

No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe).

METHODS

Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess Respiratory Risk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures of the Assess Respiratory Risk in Surgical Patients in Catalonia score's performance were calculated for the Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe cohort and three subsamples: Spain, Western Europe, and Eastern Europe.

RESULTS

The full Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe data set included 5,099 patients; 725 PPCs were recorded for 404 patients (7.9%). The score's discrimination was good: c-statistic (95% CI), 0.80 (0.78 to 0.82). Predicted versus observed PPC rates for low, intermediate, and high risk were 0.87 and 3.39% (score <26), 7.82 and 12.98% (≥ 26 and <45), and 38.13 and 38.01% (≥ 45), respectively; the positive likelihood ratio for a score of 45 or greater was 7.12 (5.93 to 8.56). The score performed best in the Western Europe subsample-c-statistic, 0.87 (0.83 to 0.90) and positive likelihood ratio, 11.56 (8.63 to 15.47)-and worst in the Eastern Europe subsample. The predicted (5.5%) and observed (5.7%) PPC rates were most similar in the Spain subsample.

CONCLUSIONS

The Assess Respiratory Risk in Surgical Patients in Catalonia score predicts three levels of PPC risk in hospitals outside the development setting. Performance differs between geographic areas.

摘要

背景

目前尚无针对术后肺部并发症（PPC）的经外部验证的风险评分。作者在一个大型欧洲队列（欧洲术后肺部并发症风险评分的前瞻性评估）中测试了评估外科患者呼吸风险的评分在 PPC 方面的通用性。

方法

63 个中心招募了 5859 名接受全身、椎管或神经丛阻滞麻醉的手术患者。记录了评估外科患者呼吸风险的评分中的因素（年龄、术前空气中动脉血氧饱和度、前一个月急性呼吸道感染、术前贫血、上腹部或胸部手术、手术持续时间和急诊手术）以及 PPC 发生情况（呼吸道感染或衰竭、支气管痉挛、肺不张、胸腔积液、气胸或吸入性肺炎）。计算了评估外科患者呼吸风险的评分在 Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe 队列和三个亚组（西班牙、西欧和东欧）中的表现的区分度、校准度和诊断准确性。

结果

完整的 Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe 数据集包括 5099 名患者；404 名患者中有 725 名发生 PPC（7.9%）。评分的区分度良好：C 统计量（95%CI）为 0.80（0.78 至 0.82）。低、中、高危的预测与观察 PPC 发生率分别为 0.87%和 3.39%（评分<26）、7.82%和 12.98%（≥26 和 <45）和 38.13%和 38.01%（≥45）；评分 45 或更高的阳性似然比为 7.12（5.93 至 8.56）。该评分在西欧亚组中的表现最佳- C 统计量为 0.87（0.83 至 0.90），阳性似然比为 11.56（8.63 至 15.47）-而在东欧亚组中的表现最差。在西班牙亚组中，预测（5.5%）和观察（5.7%）PPC 发生率最为相似。