Poullis Michael, Pullan Mark, Chalmers John, Mediratta Neeraj
Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):172-7. doi: 10.1093/icvts/ivu345. Epub 2014 Oct 27.
EuroSCORE II, despite improving on the original EuroSCORE system, has not solved all the calibration and predictability issues. We investigated the sensitivity, specificity and predictability of original EuroSCORE and EuroSCORE II system in elderly patients.
The original logistic EuroSCORE and EuroSCORE II were assessed via receiver operator characteristic (ROC) and Hosmer-Lemeshow test probability analysis with regard to accuracy of predicting in-hospital mortality. Analysis was performed on isolated coronary artery bypass graft (CABG) (n = 2913), aortic valve replacement (AVR) (n = 814), mitral valve surgery (MVR) (n = 340), combined AVR and CABG cases (n = 517) and the above cases combined (n = 4584). Elderly was defined as ≥70 years old. Age <70 was used for comparative purposes.
Institutional mortality was 2.9%, for all isolated CABG, AVR, MVR and combined AVR and CABG cases. In all patients aged ≥70 neither the original EuroSCORE nor EuroSCORE II had a ROC c-statistic above 0.7. For isolated CABG, the ROC c-statistic was not acceptable in patients ≥70 years of age, but was fine for patients under the age of 70 years. For isolated AVR the ROC c-statistic was good for patients aged less than 70 years of age for both risk models; however, the ROC was unacceptably low in patients aged ≥70 for both models. For isolated MVR, the ROC c-statistic and Hosmer-Lemeshow test probability was good for all patients regardless of age. For combined AVR and CABG, the ROC c-statistic was unacceptably low for all patients, regardless of age group using the original EuroSCORE, and in those aged ≥70 using the EuroSCORE II risk model. The original EuroSCORE had no issues with the Hosmer-Lemeshow test probability; however, EuroSCORE II had poor model predictability for all patients, P < 0.0001, and for isolated CABG, P = 0.05 and AVR, P = 0.06.
The original EuroSCORE and the EuroSCORE II risk models should be used with caution in patients aged 70 or older undergoing cardiac surgery in the modern era. Below the age of 70, both models are sensitive, specific and have good predictive power. Our work needs validation by other large groups.
欧洲心脏手术风险评估系统II（EuroSCORE II）尽管在原始EuroSCORE系统的基础上有所改进，但尚未解决所有校准和可预测性问题。我们研究了原始EuroSCORE和EuroSCORE II系统在老年患者中的敏感性、特异性和可预测性。
通过受试者工作特征（ROC）曲线和Hosmer-Lemeshow检验概率分析，评估原始逻辑EuroSCORE和EuroSCORE II对预测住院死亡率准确性的情况。对单纯冠状动脉搭桥术（CABG）（n = 2913）、主动脉瓣置换术（AVR）（n = 814）、二尖瓣手术（MVR）（n = 340）、AVR和CABG联合病例（n = 517）以及上述病例合并（n = 4584）进行分析。将年龄≥70岁定义为老年。年龄<70岁用于比较。
所有单纯CABG、AVR、MVR以及AVR和CABG联合病例的院内死亡率为2.9%。在所有年龄≥70岁的患者中，原始EuroSCORE和EuroSCORE II的ROC c统计量均未超过0.7。对于单纯CABG，年龄≥70岁患者的ROC c统计量不可接受，但70岁以下患者的该统计量良好。对于单纯AVR，两种风险模型在年龄<70岁的患者中ROC c统计量良好；然而，在年龄≥70岁的患者中，两种模型的ROC均低至不可接受。对于单纯MVR，无论年龄大小，所有患者的ROC c统计量和Hosmer-Lemeshow检验概率均良好。对于AVR和CABG联合病例，无论年龄组，使用原始EuroSCORE时所有患者的ROC c统计量均低至不可接受，使用EuroSCORE II风险模型时年龄≥70岁患者的该统计量也不可接受。原始EuroSCORE在Hosmer-Lemeshow检验概率方面没有问题；然而，EuroSCORE II对所有患者的模型预测性较差，P < 0.0001，对于单纯CABG，P = 0.05，对于AVR，P = 0.06。
在当代，对于年龄70岁及以上接受心脏手术的患者，应谨慎使用原始EuroSCORE和EuroSCORE II风险模型。70岁以下，两种模型均敏感、特异且具有良好的预测能力。我们的研究需要其他大型研究组进行验证。
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