Moscarelli Marco, Bianchi Giacomo, Margaryan Rafik, Cerillo Alfredo, Farneti Pierandrea, Murzi Michele, Solinas Marco
Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy Honorary Research Fellow, National Heart and Lung Institute (NHLI), Imperial College, London, UK
Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy.
Interact Cardiovasc Thorac Surg. 2015 Dec;21(6):748-53. doi: 10.1093/icvts/ivv265. Epub 2015 Sep 23.
EuroSCORE II has been implemented with the view to providing better performance than the previous logistic EuroSCORE. However, until now, no external validations have been carried out in the minimally invasive context. Therefore, we sought to validate the accuracy of EuroSCORE II in a retrospective series of consecutive patients undergoing minimally invasive mitral valve surgery.
Data of 1609 consecutive patients who underwent minimally invasive mitral valve surgery in our institution were retrospectively reviewed. The accuracy of EuroSCORE II was assessed in terms of discrimination and calibration. Discrimination was tested via analysis of the area under the curve of receiver operator characteristic; calibration was achieved by calculating the observed versus expected mortality ratio and the Hosmer-Lemeshow test for test probability; global accuracy was assessed by using Brier's score; results were compared with the previous logistic EuroSCORE version. EuroSCORE II performance was also tested for discrimination of postoperative complications. Discrimination subgroup analysis was carried out for single surgeon results, and for high-risk patients those outliers were defined after boxplot analysis (EuroSCORE II ≥6%).
EuroSCORE II showed good discrimination power (area under the curve 0.846), and was statistically superior to logistic EuroSCORE (P = 0.01). In terms of calibration, both EuroSCORE II and logistic over-predicted mortality; with regard to adverse events, the discrimination of EuroSCORE II was adequate for acute renal failure, low-output syndrome and increased intensive care unit stay; area under the curve of receiver operating characteristic for high-risk patients with EuroSCORE ≥6% was suboptimal (0.654); single surgeon results did not influence the discrimination of EuroSCORE II.
EuroSCORE II showed good discrimination power in our series of minimally invasive mitral valve patients; however, it over-predicted mortality. Individual performance did not influence discrimination. Performance was suboptimal for prediction of complications and for high-risk subgroup in-hospital mortality.
实施欧洲心脏手术风险评估系统（EuroSCORE）II的目的是提供比先前的逻辑EuroSCORE更好的性能。然而，到目前为止，尚未在微创环境中进行外部验证。因此，我们试图在一系列连续接受微创二尖瓣手术的患者中验证EuroSCORE II的准确性。
回顾性分析了我院1609例连续接受微创二尖瓣手术患者的数据。从区分度和校准度方面评估EuroSCORE II的准确性。通过分析受试者工作特征曲线下面积来测试区分度；通过计算观察到的与预期的死亡率比值以及检验概率的Hosmer-Lemeshow检验来实现校准；使用Brier评分评估整体准确性；将结果与先前的逻辑EuroSCORE版本进行比较。还测试了EuroSCORE II对术后并发症的区分能力。对单手术医生的结果进行区分亚组分析，对于高危患者，在箱线图分析（EuroSCORE II≥6%）后定义那些异常值。
EuroSCORE II显示出良好的区分能力（曲线下面积为0.846），并且在统计学上优于逻辑EuroSCORE（P = 0.01）。在校准方面，EuroSCORE II和逻辑EuroSCORE都高估了死亡率；关于不良事件，EuroSCORE II对急性肾衰竭、低心排血量综合征和重症监护病房停留时间延长的区分能力足够；EuroSCORE≥6%的高危患者的受试者工作特征曲线下面积不理想（0.654）；单手术医生的结果不影响EuroSCORE II的区分能力。
在我们的微创二尖瓣患者系列中，EuroSCORE II显示出良好的区分能力；然而，它高估了死亡率。个体表现不影响区分度。对于并发症的预测和高危亚组的院内死亡率，其表现不理想。
