Krenzien F, Wiltberger G, Hau H-M, Matia I, Benzing C, Atanasov G, Schmelzle M, Fellmer P T
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany; Transplant Surgery Research Laboratory and Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
Eur J Vasc Endovasc Surg. 2016 Jan;51(1):30-6. doi: 10.1016/j.ejvs.2015.07.003. Epub 2015 Aug 5.
The present study tested scoring models for ruptured abdominal aortic aneurysms (rAAAs) in patients treated by open surgical repair (OSR). Scores were tested in a European population to validate their applicability for predicting outcome.
Between 2002 and 2013, 92 patients with rAAAs underwent OSR and medical records were reviewed retrospectively. The Edinburgh Rupture Aneurysm Score (ERAS), Vascular Study Group of New England (VSGNE) rAAA risk score, Hardman Index, and Glasgow Aneurysm Score (GAS) were calculated and analyzed according to in hospital mortality. The discriminatory power and calibration of all models were assessed by applying the receiver operating characteristic and the Hosmer-Lemeshow test χ(2).
An ERAS ≤ 1 (n = 55), 2 (n = 15) and 3 (n = 16) was associated with a mortality of 27%, 47%, and 69%, respectively. The calibration was the best of all tested scores (χ(2) = 0.44; p = .81) and the area under the curve (AUC) was 0.71 (95% CI 0.6-0.82; p = .001). A VSGNE rAAA risk score = 0 (n = 19), 1 (n = 15), 2 (n = 19), 3 (n = 25), and ≥ 4 (n = 9) was associated with a mortality of 11%, 20%, 32%, 72%, and 56%, and an AUC of 0.76 (95% CI 0.66-0.87; p = .001). The calibration was reduced (χ(2) = 6.9; p = .08). The GAS and Hardman Index increased stepwise with increasing in hospital mortality, but were inferior to ERAS and the VSGNE rAAA risk score. The Hardman Index showed the smallest AUC (0.68; 95% CI 0.56-0.80; p = .011) and demonstrated a lack of fit (χ(2) = 8.2; p = .04). The GAS showed good discrimination (AUC = 0.75; 95% CI 0.64-0.85; p < .001) and calibration (χ(2) = 0.85; p = .66); however, the parametric scale of GAS limits its use to classifying patients according to their risk.
The present study revealed remarkable differences in survival between subgroups (10-70%) and underscores the need for risk stratification. The ERAS was favorable with striking ease of use and high accuracy in predicting outcome.
本研究对接受开放手术修复（OSR）的腹主动脉瘤破裂（rAAA）患者的评分模型进行了测试。在欧洲人群中对这些评分进行测试，以验证其预测预后的适用性。
2002年至2013年间，92例rAAA患者接受了OSR，并对其病历进行回顾性分析。根据住院死亡率计算并分析爱丁堡破裂动脉瘤评分（ERAS）、新英格兰血管研究组（VSGNE）rAAA风险评分、哈德曼指数和格拉斯哥动脉瘤评分（GAS）。通过应用受试者工作特征曲线和Hosmer-Lemeshow检验χ²评估所有模型的鉴别能力和校准情况。
ERAS≤1（n = 55）、2（n = 15）和3（n = 16）时，死亡率分别为27%、47%和69%。校准情况在所有测试评分中最佳（χ² = 0.44；p = 0.81），曲线下面积（AUC）为0.71（95%可信区间0.6 - 0.82；p = 0.001）。VSGNE rAAA风险评分为0（n = 19）、1（n = 15）、2（n = 19）、3（n = 25）和≥4（n = 9）时，死亡率分别为11%、20%、32%、72%和56%，AUC为0.76（95%可信区间0.66 - 0.87；p = 0.001）。校准情况有所下降（χ² = 6.9；p = 0.08）。GAS和哈德曼指数随住院死亡率的增加而逐步升高，但不如ERAS和VSGNE rAAA风险评分。哈德曼指数的AUC最小（0.68；95%可信区间0.56 - 0.80；p = 0.011），且显示拟合不佳（χ² = 8.2；p = 0.04）。GAS显示出良好的鉴别能力（AUC = 0.75；95%可信区间0.64 - 0.85；p < 0.001）和校准情况（χ² = 0.85；p = 0.66）；然而，GAS的参数范围限制了其仅用于根据患者风险进行分类。
本研究揭示了各亚组之间生存率存在显著差异（10% - 70%），强调了风险分层的必要性。ERAS具有显著优势，易于使用且预测预后的准确性高。
Zotero 插件