Nasrallah Ali A, Dakik Habib A, Abou Heidar Nassib F, Najdi Jad A, Nasrallah Oussama G, Mansour Mazen, Tamim Hani, Hajj Albert El
Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Ther Adv Urol. 2022 Mar 18;14:17562872221084847. doi: 10.1177/17562872221084847. eCollection 2022 Jan-Dec.
Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.
The cohort was derived from the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer-Lemeshow test and compared to the RCRI and the AUB-HAS2 index.
In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-ACH model utilized six variables: ge ⩾75 years, SA class >2, nemia, surgical pproach, reatinine >1.5, and history of eart disease. Index ROC analysis provided a C-statistic of 0.81, calibration was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively.
This study proposes a novel procedure-specific cardiovascular risk index. The PN-ACH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.
部分肾切除术（PN）与术后心血管疾病发病和死亡的风险不可忽视。识别高危患者可能有助于优化围手术期管理并考虑其他治疗方法。作者旨在为PN患者开发一种特定手术的心血管风险指数，并将其性能与广泛使用的修订心脏风险指数（RCRI）和AUB-HAS2心血管风险指数进行比较。
该队列来自美国外科医师学会-国家外科质量改进计划（ACS-NSQIP）数据库。主要结局是主要不良心血管事件（MACE）的发生率，定义为术后30天内心肌梗死、中风或死亡的发生率。构建了多变量逻辑回归模型；使用ROC分析和Hosmer-Lemeshow检验评估性能和校准，并与RCRI和AUB-HAS2指数进行比较。
在4795例患者的队列中，52例（1.1%）患者发生了MACE。单变量分析产生了13个符合进入多变量模型的变量。最终的PN-ACH模型使用了六个变量：年龄≥75岁、美国麻醉医师协会（ASA）分级>2、贫血、手术方式、肌酐>1.5以及心脏病史。指数ROC分析的C统计量为0.81，校准度为0.99，敏感性为85%。相比之下，RCRI和AUB-HAS2的C统计量分别为0.59和0.68。
本研究提出了一种新型的特定手术心血管风险指数。PN-ACH指数使用大型国家数据库显示出良好的预测能力和出色的校准度，可能有助于进一步实现患者护理的个体化和优化患者选择。
