Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Intavarorote Rd, Muang Chiang Mai District, Chiang Mai, 50200, Thailand.
Department of Biomedical informatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
BMC Anesthesiol. 2024 Aug 30;24(1):301. doi: 10.1186/s12871-024-02685-5.
The CARDOT scores have been developed for prediction of respiratory complications after thoracic surgery. This study aimed to externally validate the CARDOT score and assess the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for postoperative respiratory complication.
A retrospective cohort study of consecutive thoracic surgical patients at a single tertiary hospital in northern Thailand was conducted. The development and validation datasets were collected between 2006 and 2012 and from 2015 to 2021, respectively. Six prespecified predictive factors were identified, and formed a predictive score, the CARDOT score (chronic obstructive pulmonary disease, American Society of Anesthesiologists physical status, right-sided operation, duration of surgery, preoperative oxygen saturation on room air, thoracotomy), was calculated. The performance of the CARDOT score was evaluated in terms of discrimination by using the area under the receiver operating characteristic (AuROC) curve and calibration.
There were 1086 and 1645 patients included in the development and validation datasets. The incidence of respiratory complications was 15.7% (171 of 1086) and 22.5% (370 of 1645) in the development and validation datasets, respectively. The CARDOT score had good discriminative ability for both the development and validation datasets (AuROC 0.789 (95% CI 0.753-0.827) and 0.758 (95% CI 0.730-0.787), respectively). The CARDOT score showed good calibration in both datasets. A high NLR (≥ 4.5) significantly increased the risk of respiratory complications after thoracic surgery (P < 0.001). The AuROC curve of the validation cohort increased to 0.775 (95% CI 0.750-0.800) when the score was combined with a high NLR. The AuROC of the CARDOT score with the NLR showed significantly greater discrimination power than that of the CARDOT score alone (P = 0.008).
The CARDOT score showed a good discriminative performance in the external validation dataset. An addition of a high NLR significantly increases the predictive performance of CARDOT score. The utility of this score is valuable in settings with limited access to preoperative pulmonary function testing.
CARDOT 评分系统是为了预测胸外科手术后的呼吸系统并发症而开发的。本研究旨在对 CARDOT 评分系统进行外部验证，并评估术前中性粒细胞与淋巴细胞比值（NLR）对术后呼吸系统并发症的预测价值。
对泰国北部一家三级医院连续接受胸外科手术的患者进行回顾性队列研究。开发和验证数据集分别于 2006 年至 2012 年和 2015 年至 2021 年期间收集。确定了 6 个预设预测因素，并形成了一个预测评分，即 CARDOT 评分（慢性阻塞性肺疾病、美国麻醉医师协会身体状况、右侧手术、手术持续时间、术前在空气时的氧饱和度、剖胸术）。通过使用接受者操作特征曲线下面积（AuROC）评估 CARDOT 评分的区分能力来评估其性能。
开发和验证数据集中分别有 1086 例和 1645 例患者。在开发和验证数据集中，呼吸系统并发症的发生率分别为 15.7%（171/1086）和 22.5%（370/1645）。CARDOT 评分对开发和验证数据集均具有良好的区分能力（AuROC 分别为 0.789（95%CI 0.753-0.827）和 0.758（95%CI 0.730-0.787））。两个数据集的 CARDOT 评分均显示出良好的校准。高 NLR（≥4.5）显著增加了胸外科手术后呼吸系统并发症的风险（P<0.001）。当评分与高 NLR 结合时，验证队列的 AuROC 曲线增加到 0.775（95%CI 0.750-0.800）。CARDOT 评分与 NLR 结合的 AuROC 显示出比单独 CARDOT 评分更高的区分能力（P=0.008）。
CARDOT 评分在外部验证数据集中表现出良好的区分性能。高 NLR 的增加显著提高了 CARDOT 评分的预测性能。在术前肺功能检测有限的情况下，该评分的实用性具有重要价值。
