Park Y-S, Moon Y-J, Jun I-G, Song J-G, Hwang G-S
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2018 May;50(4):1108-1113. doi: 10.1016/j.transproceed.2018.01.024.
Although the revised cardiac risk index (RCRI) is a useful tool for estimating the risk of postoperative cardiac events, whether it improves the prediction of cardiac events in patients undergoing liver transplantation (LT) has not been sufficiently demonstrated.
We retrospectively analyzed 1429 patients who underwent LT. Cardiac events were defined as myocardial infarction, death, or combined events within 30 days after surgery. The RCRI was defined as the number of independent predictors including high-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin treatment, and creatinine level >2 mg/dL. Multivariate logistic regression analysis was performed to identify factors independently associated with cardiac events. The additive predictability of RCRI for the Model for End-Stage Liver Disease (MELD) score was assessed using receiver operating characteristic curve analysis.
Forty-four (3.1%) cardiac events occurred within 30 days after surgery. Both the MELD score (adjusted odds ratio [aOR], 1.05; P = .005) and RCRI (aOR, 4.35; P < .001 for RCRI score 2; aOR, 6.27; P = .009 for RCRI score 3 compared with RCRI score 1) independently predicted postoperative 30-day cardiac events. The model with MELD score plus RCRI was significantly more predictive for postoperative 30-day cardiac events than the model with MELD score alone (C-statistics 0.800 vs 0.757; P = .030).
For preoperative risk stratification, RCRI showed additive value to MELD score in predicting postoperative 30-day cardiac events after LT.
尽管修订后的心脏风险指数（RCRI）是评估术后心脏事件风险的有用工具，但它是否能改善肝移植（LT）患者心脏事件的预测尚未得到充分证实。
我们回顾性分析了1429例接受LT的患者。心脏事件定义为术后30天内发生的心肌梗死、死亡或合并事件。RCRI定义为包括高危手术、缺血性心脏病、充血性心力衰竭、脑血管疾病、胰岛素治疗以及肌酐水平>2mg/dL在内的独立预测因素的数量。进行多因素逻辑回归分析以确定与心脏事件独立相关的因素。使用受试者工作特征曲线分析评估RCRI对终末期肝病模型（MELD）评分的附加预测能力。
术后30天内发生44例（3.1%）心脏事件。MELD评分（调整优势比[aOR]，1.05；P = 0.005）和RCRI（aOR，4.35；RCRI评分为2时P < 0.001；与RCRI评分为1相比，RCRI评分为3时aOR，6.27；P = 0.009）均独立预测术后30天心脏事件。与仅使用MELD评分的模型相比，MELD评分加RCRI的模型对术后30天心脏事件的预测能力显著更强（C统计量0.800对0.757；P = 0.030）。
对于术前风险分层，RCRI在预测LT术后30天心脏事件方面对MELD评分具有附加价值。
