术前肺部超声评分对接受脊柱麻醉下髋关节置换术老年患者主要心脏不良事件预测的准确性：LUSHIP 多中心观察性前瞻性研究。

Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia: The LUSHIP multicenter observational prospective study.

机构信息

Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy; Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy.

Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy. Electronic address: https://twitter.com/ricoboero.

出版信息

Anaesth Crit Care Pain Med. 2024 Dec;43(6):101432. doi: 10.1016/j.accpm.2024.101432. Epub 2024 Oct 5.

DOI:10.1016/j.accpm.2024.101432

PMID:39369987

Abstract

BACKGROUND AND OBJECTIVE

We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA).

METHODS

Prospective, observational multicenter study of 11 Italian hospitals on patients aged >65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy.

RESULTS

A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 vs. 4.97 ± 4.90 (p < 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (p < 0.001), MICA scores (p = 0.001) and ASA classes (p < 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55-9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, p < 0.001.

CONCLUSIONS

The preoperative LUS score, with its high negative predictive value, could improve patients' risk stratification when used alone or add further value to the RCRI score.

REGISTRATION

Registered at clinicaltrials.gov as NCT04074876.

摘要

背景与目的

我们假设肺部超声评分（LUS）可帮助评估老年髋部骨折患者接受骨科手术的心脏风险，从而为修订后的心脏风险指数（RCRI）、美国麻醉医师协会身体状况评分（ASA-PS）和国家手术质量改进计划心肌梗死和心搏骤停（NSQIP-MICA）提供附加价值。

方法

这是一项在意大利 11 家医院开展的前瞻性、观察性多中心研究，纳入年龄>65 岁且需紧急手术的髋部骨折患者。排除 6 个月内发生重大不良心血管事件（MACE）或有急性心力衰竭的患者。经过培训的麻醉医师在术前评估期间获取术前 LUS 评分。采用 ROC 曲线分析和比较评估检测准确性。

结果

研究期间共纳入 877 例患者。98 例患者共发生 108 例 MACE 事件，总发生率为 11.2%。复杂病例的 LUS 评分高于非复杂病例，分别为 11.6±6.64 与 4.97±4.90（p<0.001）。术前 LUS 评分≥8 预测 MACE 的 AUC（0.78）和准确性（0.76）均优于 RCRI 评分（p<0.001）、MICA 评分（p=0.001）和 ASA 分级（p<0.001）。LUS 的灵敏度为 0.71，特异性为 0.76，阴性预测值为 0.95。多因素分析显示，术前 LUS 评分≥8 时，MACE 的 OR 为 5.81[95%CI 3.55-9.69]。91 例（10.4%）患者发生术后肺炎，非肺炎组的术前 LUS 评分更高（p<0.001）。