在传统风险评分中加入白蛋白可改善经导管主动脉瓣置换术患者的死亡率预测。
Addition of albumin to Traditional Risk Score Improved Prediction of Mortality in Individuals Undergoing Transcatheter Aortic Valve Replacement.
作者信息
Grossman Yoni, Barbash Israel M, Fefer Paul, Goldenberg Ilan, Berkovitch Anat, Regev Ehud, Fink Noam, Ben-Zekry Sagit, Brodov Yafim, Kogan Alexander, Guetta Victor, Raanani Ehud, Segev Amit
机构信息
Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
出版信息
J Am Geriatr Soc. 2017 Nov;65(11):2413-2417. doi: 10.1111/jgs.15070. Epub 2017 Sep 23.
OBJECTIVES
The ability of the Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE)-2 scores to predict outcomes after transcatheter aortic valve replacement (TAVR) is insufficient. Frailty and serum albumin as a frailty marker were shown to correlate with prognosis after TAVR. We sought to evaluate the additive value of serum albumin to STS and EuroSCORE-2 scores to predict mortality in individuals undergoing TAVR.
DESIGN
Retrospective analysis.
SETTING
Tertiary-care hospital prospective registry.
PARTICIPANTS
Individuals who underwent TAVR (N = 426).
MEASUREMENTS
We compared survival rates according to median baseline albumin levels (4 g/dL), STS score (4.5%), and EuroSCORE-2 (3.45%). Participants were divided into four groups according to median serum albumin and median STS and EuroSCORE-2 scores (high vs low), and 1-year survival rates were compared. A category-free net reclassification index (NRI) was calculated to compare the ability of a model of STS or EuroSCORE-2 alone to classify mortality risk with and without the addition of baseline serum albumin.
RESULTS
Participants with low albumin levels had higher mortality (hazard ratio (HR) = 3.03, 95% confidence interval (CI) = 1.66-5.26, P < .001). Participants with low serum albumin and a high STS (HR = 4.55, 95% CI = 2.21-9.38, P < .001) or EuroSCORE-2 (HR = 2.72, 95% CI = 1.48-5.06, P = .001) score had higher mortality. Using NRI analysis, a model that included albumin in addition to STS correctly reclassified 42% of events (NRI = 0.58) and a model that included albumin in addition to EuroSCORE-2 correctly reclassified 44% of events (NRI = 0.64).
CONCLUSION
Serum albumin, as a marker of frailty, can significantly improve the ability of STS and EuroSCORE-2 scores to predict TAVR-related mortality.
目的
胸外科医师协会（STS）评分和欧洲心脏手术风险评估系统（EuroSCORE）-2评分预测经导管主动脉瓣置换术（TAVR）后结局的能力不足。衰弱以及作为衰弱标志物的血清白蛋白已被证明与TAVR后的预后相关。我们旨在评估血清白蛋白对STS和EuroSCORE-2评分的附加价值，以预测接受TAVR的个体的死亡率。
设计
回顾性分析。
背景
三级医疗医院前瞻性登记处。
参与者
接受TAVR的个体（N = 426）。
测量
我们根据基线白蛋白水平中位数（4 g/dL）、STS评分（4.5%）和EuroSCORE-2评分（3.45%）比较生存率。参与者根据血清白蛋白中位数以及STS和EuroSCORE-2评分中位数（高vs低）分为四组，并比较1年生存率。计算无类别净重新分类指数（NRI），以比较单独使用STS或EuroSCORE-2模型在添加和不添加基线血清白蛋白的情况下对死亡风险进行分类的能力。
结果
白蛋白水平低的参与者死亡率更高（风险比[HR]=3.03，95%置信区间[CI]=1.66-5.26，P<.001）。血清白蛋白水平低且STS评分高（HR = 4.55，95%CI = 2.21-9.38，P<.001）或EuroSCORE-2评分高（HR = 2.72，95%CI = 1.48-5.06，P =.001）的参与者死亡率更高。使用NRI分析，除STS外还包括白蛋白的模型正确重新分类了42%的事件（NRI = 0.58），除EuroSCORE-2外还包括白蛋白的模型正确重新分类了44%的事件（NRI = 0.64）。
结论
血清白蛋白作为衰弱标志物，可显著提高STS和EuroSCORE-2评分预测TAVR相关死亡率的能力。
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