Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Anesthesiology, Intensive Care, and Pain Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):2983-2990. doi: 10.1053/j.jvca.2022.02.029. Epub 2022 Feb 26.
Accurate preoperative transfusion risk stratification may serve to better manage older patients undergoing cardiac surgery. Therefore, the aim of the present study was to externally validate the existing Association of Cardiothoracic Anesthetists perioperative risk of blood transfusion (ACTA-PORT) score in a population ≥70 years of age scheduled for cardiac surgery. Furthermore, the study authors investigated the additional prognostic value of individual frailty variables to this transfusion risk score.
A retrospective analysis.
At a tertiary-care hospital.
Five hundred seven patients aged ≥70 years undergoing elective cardiac surgery from July 2015 to August 2017.
None.
The primary outcome was the administration of a perioperative blood transfusion. Frailty domains were assessed in a preanesthesia geriatric assessment, and a priori selection of biomarkers derived from blood was determined. The original ACTA-PORT score resulted in a c-statistic of 0.78 (95% confidence interval 0.74-0.82), with moderate calibration in predicting perioperative allogeneic transfusion in older patients undergoing cardiac surgery. Model updating, using the closed testing procedure, resulted in model revision with a higher discriminatory performance (c-statistic of 0.83, 95% confidence interval 0.79-0.86) and corrected calibration slope. Iron deficiency, impaired nutritional status, and physical impairment were associated with perioperative transfusions. The addition of individual frailty variables to the updated ACTA-PORT model did not result in improved predictive performance.
External validation of the original ACTA-PORT score showed good discrimination and moderate calibration in older patients at risk of frailty undergoing cardiac surgery. Updating the original ACTA-PORT improved the predictive performance. Careful evaluation of additional frailty domains did not add prognostic value to the ACTA-PORT score.
准确的术前输血风险分层有助于更好地管理接受心脏手术的老年患者。因此，本研究的目的是在≥70 岁接受心脏手术的人群中对现有的心胸麻醉医师协会围手术期输血风险评分（ACTA-PORT）进行外部验证。此外，研究作者还探讨了个体脆弱性变量对该输血风险评分的额外预后价值。
回顾性分析。
在一家三级保健医院。
2015 年 7 月至 2017 年 8 月期间接受择期心脏手术的≥70 岁的 507 例患者。
无。
主要结局是围手术期输血。在术前老年评估中评估虚弱领域，并预先确定来自血液的生物标志物的选择。原始的 ACTA-PORT 评分的 C 统计量为 0.78（95%置信区间 0.74-0.82），在预测接受心脏手术的老年患者围手术期异体输血方面具有中等校准度。使用封闭测试程序进行的模型更新导致模型修订，具有更高的区分性能（C 统计量为 0.83，95%置信区间 0.79-0.86）和校正校准斜率。缺铁、营养状况受损和身体损伤与围手术期输血相关。将个体脆弱性变量添加到更新后的 ACTA-PORT 模型中并没有提高预测性能。
对原始 ACTA-PORT 评分进行外部验证表明，在接受心脏手术的易发生衰弱的老年患者中具有良好的区分度和中等的校准度。更新原始的 ACTA-PORT 提高了预测性能。仔细评估其他脆弱性领域并没有为 ACTA-PORT 评分增加预后价值。
