Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK.
Br J Anaesth. 2017 Sep 1;119(3):394-401. doi: 10.1093/bja/aex205.
A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking.
We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score.
Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients.
The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.
缺乏一种简单而准确的评分系统来预测接受心脏手术的患者的输血风险。
我们通过单因素分析确定与输血相关的独立风险因素，然后进行逻辑回归。接着，我们将评分简化为整数制系统，并使用接受者操作特征曲线（ROC）下的面积（AUC）统计量以及 Hosmer-Lemeshow 拟合优度检验进行测试。最后，我们将评分系统应用于外部验证数据集，并应用相同的统计方法来检验 ACTA-PORT 评分的准确性。
几个因素与输血风险独立相关，包括年龄、性别、体表面积、逻辑 EuroSCORE、术前血红蛋白和肌酐以及手术类型。在我们的主要数据集，该评分准确预测了心脏手术患者围手术期输血的风险，AUC 为 0.76。外部验证证实了评分方法的准确性，AUC 为 0.84，并且在所有评分中均具有良好的一致性，只是在极高风险患者中存在轻微的低估输血风险的趋势。
ACTA-PORT 评分是一种可靠的、经过验证的预测心脏手术患者输血风险的工具。该评分和其他评分可用于研究中评估结果时的风险调整，也可纳入患者血液管理计划。
