食管手术患者中O-POSSUM评分与ASA及APACHE II评分的评估

Evaluation of O-POSSUM vs ASA and APACHE II scores in patients undergoing oesophageal surgery.

作者信息

Fodor Raluca, Cioc Adrian, Grigorescu Bianca, Lăzescu Bogdan, Copotoiu Sanda Maria

机构信息

Anaesthesiology and Intensive Care Department, University of Medicine and Pharmacy of Tîrgu Mureş, Romania.

Anaesthesiology and Intensive Care Clinic, Clinical County Emergency Hospital Mureş, Romania.

出版信息

Rom J Anaesth Intensive Care. 2015 Apr;22(1):7-12.

PMID:28913449

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5505336/

Abstract

BACKGROUND AND AIMS

Risk and prognostic scores quantify the patient's risk of death or complication according to the severity of his illness. The aim of this study was to evaluate the predictive accuracy of O-POSSUM vs ASA and APACHE II models on patients undergoing oesophageal surgery.

MATERIAL AND METHOD

In this observational retrospective study 55 patients were enrolled who had undergone surgical interventions of excision and reconstruction of the oesophagus for neoplastic oesophageal stenosis, in the Surgical Clinics (I and II) of the Clinical County Emergency Hospital Mures, between January 2011 and January 2014. By using patients file records after extracting the data we calculated the predictive mortality, according to the prognostic scores O-POSSUM, ASA and APACHE II and we analyzed its correlations with the postoperative evolution. We evaluated the discriminatory power of the three scores using the ROC (receiver-operating characteristic) curves. According to the cut-off value corresponding to each score, we compared the Kaplan Meier survival curves during the hospitalization period.

RESULTS

ROC curves analysis revealed that O-POSSUM had a better discriminatory power for mortality compared to the other two scores: AUC = 0.73 for O-POSSUM, AUC = 0.57 for APACHE II and AUC = 0.64 for ASA (p < 0.001). The cut-off value was statistically significant only in case of O-POSSUM, as it derives from the statistical analysis of the survival curves (p = 0.035).

CONCLUSION

O-POSSUM predicts mortality more accurately compared to ASA or APACHE II in patients undergoing oesophageal surgery.

摘要

背景与目的

风险和预后评分可根据患者病情严重程度量化其死亡或并发症风险。本研究旨在评估O-POSSUM模型与美国麻醉医师协会（ASA）和急性生理与慢性健康状况评分系统II（APACHE II）模型对接受食管手术患者的预测准确性。

材料与方法

在这项观察性回顾性研究中，纳入了2011年1月至2014年1月期间在穆列什县临床急诊医院外科临床科室（I和II）接受手术干预以切除和重建肿瘤性食管狭窄的55例患者。通过使用患者档案记录，在提取数据后，我们根据O-POSSUM、ASA和APACHE II预后评分计算预测死亡率，并分析其与术后病情演变的相关性。我们使用ROC（受试者工作特征）曲线评估这三个评分的鉴别能力。根据每个评分对应的临界值，我们比较了住院期间的Kaplan Meier生存曲线。

结果

ROC曲线分析显示，与其他两个评分相比，O-POSSUM对死亡率具有更好的鉴别能力：O-POSSUM的AUC = 0.73，APACHE II的AUC = 0.57，ASA的AUC = 0.64（p < 0.001）。临界值仅在O-POSSUM情况下具有统计学意义，因为它来自生存曲线的统计分析（p = 0.035）。