Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac291.
To develop a risk model for predicting postoperative mortality and morbidity in patients with interstitial lung disease undergoing surgical lung biopsy.
From 2004 to 2019, patients who underwent surgical lung biopsy for interstitial lung disease were included in this study. Based on the findings of the multivariable analysis using preoperative clinical variables, a risk model for predicting postoperative mortality and morbidity was developed.
During the study period, 1177 patients were enrolled. Among them, morbidity and mortality occurred in 45 (3.8%) and 29 (2.5%) patients, respectively, which gradually declined over time from 8.9% in 2004-2005 to 0% in 2018-2019. In the final multivariable analysis, the dyspnoea grade, a forced vital capacity of ≤60%, preoperative oxygen therapy and preoperative intensive care unit stay were found to be the independent factors associated with both morbidity and mortality; smoking >40 pack-years was additionally identified as a factor related to mortality. Diffusing capacity of carbon monoxide ≤50%, which was a significant factor in the univariable analysis, became insignificant after adjustment for the forced vital capacity in the multivariable analysis. The risk scoring system based on this model showed a good discriminant ability for both morbidity [area under the receiver operating characteristic curve (95% confidence interval): 0.830 (0.726-0.932)] and mortality [0.887 (0.804-0.975)].
We developed a scoring system for predicting the risk of morbidity and mortality, which could help determine surgical candidates for lung biopsy among patients with interstitial lung disease.
建立一个预测行外科肺活检的间质性肺疾病患者术后死亡率和发病率的风险模型。
本研究纳入了 2004 年至 2019 年间因间质性肺疾病行外科肺活检的患者。基于术前临床变量的多变量分析结果，建立了一个预测术后死亡率和发病率的风险模型。
研究期间共纳入 1177 例患者。其中，45 例（3.8%）发生了发病率，29 例（2.5%）发生了死亡率，发病率从 2004-2005 年的 8.9%逐渐下降至 2018-2019 年的 0%，死亡率则从 2004-2005 年的 3.7%逐渐下降至 2018-2019 年的 0%。最终的多变量分析结果显示，呼吸困难分级、用力肺活量≤60%、术前氧疗和术前重症监护病房住院是与发病率和死亡率相关的独立因素；吸烟>40 包年则是与死亡率相关的另一个因素。一氧化碳弥散量≤50%在单变量分析中是一个显著因素，但在多变量分析中，调整用力肺活量后则变得不显著。基于该模型的风险评分系统对发病率（接受者操作特征曲线下面积[95%置信区间]：0.830 [0.726-0.932]）和死亡率[0.887（0.804-0.975）]均具有良好的判别能力。
我们建立了一个预测发病率和死亡率风险的评分系统，有助于确定间质性肺疾病患者中进行肺活检的手术候选者。
