Bai Yunpeng, Wang Lianqun, Guo Zhigang, Chen Qingliang, Jiang Nan, Dai Jianxing, Liu Jianshi
Graduate College of Tianjin Medical University, Tianjin, China.
Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China.
Interact Cardiovasc Thorac Surg. 2016 Nov;23(5):733-739. doi: 10.1093/icvts/ivw224. Epub 2016 Jul 21.
The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was developed to update EuroSCORE and incorporated refinement and modification of several risk factors. SinoSCORE was designed by Chinese scholars based on 9839 patients who underwent coronary artery bypass grafting (CABG) at 43 participating institutions. This study was designed to validate the EuroSCORE II and SinoSCORE in Chinese patients undergoing CABG and to compare their performance overall and per subgroup.
A total of 4507 adult receiving CABG at our institution between January 2010 and April 2014 were included in this retrospective study. Patients were stratified for cardiovascular risk using EuroSCORE II and SinoSCORE. The performance of EuroSCORE II and SinoSCORE was analysed with a focus on discrimination power and calibration.
The in-hospital mortality rate for the entire cohort was 1.4%, while the mortality rate predicted by EuroSCORE II was 1.47 ± 1.2% (95% CI 1.43-1.50) and by SinoSCORE was 2.86 ± 3.5% (95% CI 2.76-2.96). The C-statistics of EuroSCORE II and SinoSCORE were 0.728 and 0.716, respectively. The Hosmer-Lemeshow test indicated that EuroSCORE II had poor goodness of fit while SinoSCORE performed slightly better. When patients were divided into quartiles based on predicted risk, respectively defined as group I, II, III and IV, EuroSCORE II underestimated mortality rates of patients scored IV, but overestimated mortality rates in all other groups; SinoSCORE underestimated mortality rates of patients scored I and overestimated mortality rates in all other groups. EuroSCORE II only achieved good discrimination for patients scored I (area under the receiver operating characteristic curve, AUC = 0.707 > 0.70), and SinoSCORE achieved poor discrimination for all subgroups except group II (AUC = 0.754 > 0.70). EuroSCORE II overestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries. SinoSCORE overestimated mortality rates in all pathology subgroups. The AUC values of EuroSCORE II and SinoSCORE were 0.694 and 0.687, respectively, for isolated CABG. The AUC values of EuroSCORE II and SinoSCORE were 0.772 and 0.669 for combined cardiac surgery CABG.
EuroSCORE II could predict mortality in the entire group and in the low-middle risk group, but not in the high-risk group, in which it underestimated mortality. SinoSCORE overestimated mortality rates in the entire group and in all subgroups. Risk models should be targeted to different heart diseases, and the statistical methods of established risk systems should be improved.
欧洲心脏手术风险评估系统II（EuroSCORE II）旨在更新EuroSCORE，并纳入了对多个风险因素的细化和修正。中国学者基于43家参与机构的9839例行冠状动脉旁路移植术（CABG）的患者设计了中国心脏手术风险评估系统（SinoSCORE）。本研究旨在验证EuroSCORE II和SinoSCORE在中国行CABG患者中的有效性，并比较它们在总体及各亚组中的表现。
本回顾性研究纳入了2010年1月至2014年4月期间在我院接受CABG的4507例成年患者。使用EuroSCORE II和SinoSCORE对患者的心血管风险进行分层。重点分析EuroSCORE II和SinoSCORE的辨别能力和校准情况。
整个队列的院内死亡率为1.4%，而EuroSCORE II预测的死亡率为1.47±1.2%（95%可信区间1.43 - 1.50），SinoSCORE预测的死亡率为2.86±3.5%（95%可信区间2.76 - 2.96）。EuroSCORE II和SinoSCORE的C统计量分别为0.728和0.716。Hosmer-Lemeshow检验表明EuroSCORE II的拟合优度较差，而SinoSCORE的表现稍好。当根据预测风险将患者分为四分位数时，分别定义为I、II、III和IV组，EuroSCORE II低估了IV组患者的死亡率，但高估了所有其他组的死亡率；SinoSCORE低估了I组患者的死亡率，高估了所有其他组的死亡率。EuroSCORE II仅对I组患者有良好的辨别能力（受试者操作特征曲线下面积，AUC = 0.707>0.70），而SinoSCORE除II组外对所有亚组的辨别能力均较差（AUC = 0.754>0.70）。EuroSCORE II高估了单纯CABG组的死亡率，低估了其他心脏手术患者的死亡率。SinoSCORE高估了所有病理亚组的死亡率。对于单纯CABG，EuroSCORE II和SinoSCORE的AUC值分别为0.694和0.687。对于联合心脏手术CABG，EuroSCORE II和SinoSCORE的AUC值分别为0.772和0.669。
EuroSCORE II可以预测整个组和中低风险组的死亡率，但不能预测高风险组的死亡率，在高风险组中它低估了死亡率。SinoSCORE高估了整个组和所有亚组的死亡率。风险模型应针对不同的心脏病，并且应改进已建立风险系统的统计方法。
