Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2613-2623. doi: 10.1053/j.jvca.2024.08.018. Epub 2024 Aug 17.
To compare sensitivity, specificity, receiver operating characteristic (ROC), and area under the curve (AUC) values using the modified Frailty Index 11 (mFI-11), EuroSCORE II, and combined mFI-11 and EuroSCORE II to predict in-hospital mortality and composite morbidities.
Retrospective cohort study SETTING: Songklanagarind Hospital, a tertiary care center in southern Thailand.
Elderly patients age ≥60 years who underwent elective open-heart surgical procedures on a pump between January 2017 and December 2022 were included.
ROC curves were constructed to evaluate the discriminatory power of EuroSCORE II and mFI-11 for predicting in-hospital mortality and postoperative complications.
The actual in-hospital mortality was 2.5% for all patients. The discriminative accuracy of mFI-11, EuroSCORE II, and combined mFI-11 with EuroSCORE II for predicting in-hospital mortality was good, with respective AUC values of 0.733 (95% confidence interval [CI], 0.6157-0.8499), 0.793 (95% CI, 0.6826-0.9026), and 0.78 (95% CI, 0.6686-0.893). The AUC of mFI-11 for predicting postoperative cardiac, respiratory, neurologic, and renal complications was 0.558 (95% CI, 0.5101-0.6063), 0.606 (95% CI, 0.5542-0.6581), 0.543 (95% CI, 0.4533-0.6337), and 0.652 (95% CI, 0.5859-0.7179), respectively, and that of EuroSCORE II was 0.553 (95% CI, 0.5038-0.6013), 0.631 (95% CI, 0.578-0.6836), 0.619 (95% CI, 0.5306-0.7076), and 0.702 (95% CI, 0.6378-0.7657), respectively.
The mFI-11 and EuroSCORE II demonstrated good discrimination in ROC analysis, with EuroSCORE II showing superior predictive accuracy for in-hospital mortality in elderly elective cardiac surgery patients. However, neither score independently predicted mortality in multiple logistic regression, nor did combining them enhance predictive power significantly. Furthermore, both scores were less effective in predicting postoperative complications.
比较改良虚弱指数 11 （mFI-11）、欧洲心脏手术风险评分 II （EuroSCORE II）以及两者联合应用在预测住院死亡率和复合病残率方面的敏感性、特异性、受试者工作特征（ROC）曲线和曲线下面积（AUC）值。
回顾性队列研究
泰国南部宋卡那格欣医院，一个三级护理中心。
2017 年 1 月至 2022 年 12 月期间在有泵的情况下接受择期开胸心脏手术的年龄≥60 岁的老年患者。
构建 ROC 曲线以评估 EuroSCORE II 和 mFI-11 预测住院死亡率和术后并发症的区分能力。
所有患者的实际住院死亡率为 2.5%。mFI-11、EuroSCORE II 和 mFI-11 与 EuroSCORE II 联合预测住院死亡率的判别准确性较好，各自的 AUC 值分别为 0.733（95%置信区间[CI]，0.6157-0.8499）、0.793（95%CI，0.6826-0.9026）和 0.78（95%CI，0.6686-0.893）。mFI-11 预测术后心脏、呼吸、神经和肾脏并发症的 AUC 值分别为 0.558（95%CI，0.5101-0.6063）、0.606（95%CI，0.5542-0.6581）、0.543（95%CI，0.4533-0.6337）和 0.652（95%CI，0.5859-0.7179），而 EuroSCORE II 的 AUC 值分别为 0.553（95%CI，0.5038-0.6013）、0.631（95%CI，0.578-0.6836）、0.619（95%CI，0.5306-0.7076）和 0.702（95%CI，0.6378-0.7657）。
mFI-11 和 EuroSCORE II 在 ROC 分析中均具有良好的区分能力，EuroSCORE II 对老年择期心脏手术患者的住院死亡率具有更高的预测准确性。然而，在多变量逻辑回归中，没有一个评分能够独立预测死亡率，联合使用也不能显著提高预测能力。此外，这两个评分在预测术后并发症方面效果都不理想。
