General Surgery Clinic, Center for Anestesiology and Reanimatology, Clinical Center in Niš, Bulevar Dr Zorana Djindjica 48, Niš, 18000, Serbia.
Department for Biochemistry, Medical School, University in Niš, Bulevar Dr Zorana Djindjica 81, Niš, 18000, Serbia.
Aging Clin Exp Res. 2019 Sep;31(9):1207-1217. doi: 10.1007/s40520-018-1072-0. Epub 2018 Nov 19.
Our previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality.
The aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP.
We have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories.
All of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853-1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876-1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided.
Addition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors.
Cardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the "multimarker approach" adds the most to the accuracy of the combination of clinical risk scores.
我们之前的研究表明，美国麻醉医师协会身体状况分类（ASA）评分和美国外科医师学会国家手术质量改进计划（ACS NSQIP）计算器在预测术后死亡率方面最为准确。
我们的研究目的是确定与 ASA 和 ACS NSQIP 最相关的心脏生物标志物的最佳组合。
我们共纳入了 78 例患者。ASA 评分采用标准方法确定，而 ACS NSQIP 评分则使用了可用的交互式计算器。在专门的实验室测量了生物标志物 BIRC5、H-FABP 和 hsCRP。
所有死亡患者的 survivin（BIRC5）均>4.00 pg/ml，H-FABP 和 hsCRP 水平更高，ASA 和 ACS NSQIP 评分更高（P=0.0001）。ASA 和 ACS NSQIP 单独的 AUC 分别为 0.669 和 0.813。ASA 和 ACS NSQIP 的组合 AUC 为 0.841。hsCRP 与两个风险评分的组合 AUC 为 0.926（95%CI 0.853-1.000，P<0.0001）。如果我们将三种心脏生物标志物添加到该模型中，我们得到的 AUC 高达 0.941（95%CI 0.876-1.000，P<0.0001）。用合并症（CIRS-G 评分）校正统计模型并没有改变我们提供的预测模型的准确性。
ACS NSQIP 和生物标志物的加入增加了 ASA 评分的准确性，这已经被其他作者证明。
hsCRP 可作为最可靠的心脏生物标志物；然而，“多标志物方法”可最大程度地提高临床风险评分组合的准确性。
