Shan Lingtong, Ge Wen, Pu Yiwei, Cheng Hong, Cang Zhengqiang, Zhang Xing, Li Qifan, Xu Anyang, Wang Qi, Gu Chang, Zhang Yangyang
The First Clinical Medical College, Nanjing Medical University, Nanjing, China.
Department of Cardiothoracic Surgery, Shuguang Hospital affiliated to Shanghai University of TCM, Shanghai, China.
PeerJ. 2018 Feb 23;6:e4413. doi: 10.7717/peerj.4413. eCollection 2018.
To assess and compare the predictive ability of three risk evaluation systems (SinoSCORE, EuroSCORE II and the STS risk evaluation system) in patients aged ≥70, and who underwent coronary artery bypass grafting (CABG) in East China.
Three risk evaluation systems were applied to 1,946 consecutive patients who underwent isolated CABG from January 2004 to September 2016 in two hospitals. Patients were divided into two subsets according to their age: elderly group (age ≥70) with a younger group (age <70) used for comparison. The outcome of interest in this study was in-hospital mortality. The entire cohort and subsets of patients were analyzed. The calibration and discrimination in total and in subsets were assessed by the Hosmer-Lemeshow and the C statistics respectively.
Institutional overall mortality was 2.52%. The expected mortality rates of SinoSCORE, EuroSCORE II and the STS risk evaluation system were 0.78(0.64)%, 1.43(1.14)% and 0.78(0.77)%, respectively. SinoSCORE achieved the best discrimination (the area under the receiver operating characteristic curve (AUC) = 0.829), followed by the STS risk evaluation system (AUC = 0.790) and EuroSCORE II (AUC = 0.769) in the entire cohort. In the elderly group, the observed mortality rate was 4.82% while it was 1.38% in the younger group. SinoSCORE (AUC = .829) also achieved the best discrimination in the elderly group, followed by the STS risk evaluation system (AUC = .730) and EuroSCORE II (AUC = 0.640) while all three risk evaluation systems all had good performances in the younger group. SinoSCORE, EuroSCORE II and the STS risk evaluation system all achieved positive calibrations in the entire cohort and subsets.
The performance of the three risk evaluation systems was not ideal in the entire cohort. In the elderly group, SinoSCORE appeared to achieve better predictive efficiency than EuroSCORE II and the STS risk evaluation system.
评估并比较三种风险评估系统（中国心脏手术风险评估系统（SinoSCORE）、欧洲心脏手术风险评估系统II（EuroSCORE II）和胸外科医师协会（STS）风险评估系统）对华东地区年龄≥70岁且接受冠状动脉旁路移植术（CABG）患者的预测能力。
将三种风险评估系统应用于2004年1月至2016年9月在两家医院连续接受单纯CABG的1946例患者。根据年龄将患者分为两个亚组：老年组（年龄≥70岁）和较年轻组（年龄<70岁）用于比较。本研究关注的结局是住院死亡率。对整个队列和患者亚组进行分析。分别采用Hosmer-Lemeshow检验和C统计量评估总体及亚组的校准度和区分度。
机构总体死亡率为2.52%。SinoSCORE、EuroSCORE II和STS风险评估系统的预期死亡率分别为0.78(0.64)%、1.43(1.14)%和0.78(0.77)%。在整个队列中，SinoSCORE的区分度最佳（受试者操作特征曲线下面积（AUC）=0.829），其次是STS风险评估系统（AUC = 0.790）和EuroSCORE II（AUC = 0.769）。在老年组中，观察到的死亡率为4.82%，而在较年轻组中为1.38%。SinoSCORE（AUC = 0.829）在老年组中也具有最佳区分度，其次是STS风险评估系统（AUC = 0.730）和EuroSCORE II（AUC = 0.640），而所有三种风险评估系统在较年轻组中均表现良好。SinoSCORE、EuroSCORE II和STS风险评估系统在整个队列和亚组中均实现了正校准。
在整个队列中，三种风险评估系统的表现并不理想。在老年组中，SinoSCORE似乎比EuroSCORE II和STS风险评估系统具有更好的预测效率。
