Musa Ahmad Farouk, Cheong Xian Pei, Dillon Jeswant, Nordin Rusli Bin
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
Department of Cardiothoracic Surgery, National Heart Institute , Kuala Lumpur, Malaysia.
F1000Res. 2018 May 2;7:534. doi: 10.12688/f1000research.14760.2. eCollection 2018.
: The European System for Cardiac Operative Risk (EuroSCORE) II was developed in 2011 to replace the aging EUROScore for predicting in-house mortality after cardiac surgery. Our aim was to validate EuroSCORE II in Malaysian patients undergoing coronary artery bypass graft (CABG) surgery at our Institute. : A retrospective single-center study was performed. A database was created to include EuroSCORE II values and actual mortality of 1718 patients undergoing CABG surgery in Malaysia from 1st January to 31st December 2016. The goodness-of-fit of EuroSCORE II was determined by the Hosmer-Lemeshow goodness-of-fit test and discriminatory power with the areas under the receiver operating characteristics (ROC) curve (AUC). Observed mortality rate was 4.66% (80 out of 1718 patients). The median EuroSCORE II value was 2.06% (Inter Quartile Range: 1.94%) (1st quartile: 1.45%, 3rd quartile: 3.39%). The AUC for EuroSCORE II was 0.7 (95% CI 0.640 - 0.759) indicating good discriminatory power. The Hosmer-Lemeshow goodness-of-fit test did not show significant difference between expected and observed mortality in accordance to the EuroSCORE II model (Chi-square = 13.758, p = 0.089) suggesting good calibration of the model in this population. Cross-tabulation analysis showed that there is slight overestimation of EuroSCORE II in low-risk groups (0-10%) and slight underestimation in high-risk groups (>20%). Multivariate logistic regression analysis showed that gender, age, total hospital stay, serum creatinine and critical pre-operative state are significant predictors of mortality post-CABG surgery. : This study indicated that the EuroSCORE II is a good predictor of post-operative mortality in the context of Malaysian patients undergoing CABG surgery. Our study also showed that certain independent variables might possess higher weightage in predicting mortality among this patient group. Therefore, it is suggested that EuroSCORE II can be safely used for risk assessment while ideally, clinical consideration should be applied on an individual basis.
欧洲心脏手术风险评估系统（EuroSCORE）II于2011年开发，以取代陈旧的EuroSCORE，用于预测心脏手术后的院内死亡率。我们的目的是在我院对接受冠状动脉旁路移植术（CABG）的马来西亚患者中验证EuroSCORE II。进行了一项回顾性单中心研究。创建了一个数据库，纳入2016年1月1日至12月31日在马来西亚接受CABG手术的1718例患者的EuroSCORE II值和实际死亡率。通过Hosmer-Lemeshow拟合优度检验确定EuroSCORE II的拟合优度，并通过受试者操作特征（ROC）曲线下面积（AUC）确定其鉴别力。观察到的死亡率为4.66%（1718例患者中有80例）。EuroSCORE II的中位数为2.06%（四分位间距：1.94%）（第一四分位数：1.45%，第三四分位数：3.39%）。EuroSCORE II的AUC为0.7（95%CI 0.640 - 0.759），表明具有良好的鉴别力。根据EuroSCORE II模型，Hosmer-Lemeshow拟合优度检验未显示预期死亡率与观察到的死亡率之间存在显著差异（卡方=13.758，p = 0.089），表明该模型在该人群中校准良好。交叉表分析显示，EuroSCORE II在低风险组（0 - 10%）中略有高估，在高风险组（>20%）中略有低估。多因素逻辑回归分析显示，性别、年龄、住院总时长（总住院时间）、血清肌酐和术前危急状态是CABG术后死亡率的显著预测因素。这项研究表明，EuroSCORE II是马来西亚接受CABG手术患者术后死亡率的良好预测指标。我们的研究还表明，某些独立变量在预测该患者群体的死亡率时可能具有更高的权重。因此，建议可以安全地使用EuroSCORE II进行风险评估，而理想情况下应根据个体情况进行临床考量。 （注：原文中“total hospital stay”直译为总住院停留，这里意译为总住院时间更符合中文表达习惯）
