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[非心脏手术患者术前风险预测模型:正确解读和使用风险评分]

[Preoperative risk prediction models for noncardiac surgery patients : Interpret and use risk scores correctly].

作者信息

M'Pembele René, Roth Sebastian, Lurati Buse Giovanna

机构信息

Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.

CARID (Cardiovascular Research Institute Düsseldorf), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland.

出版信息

Anaesthesiologie. 2024 Dec;73(12):861-870. doi: 10.1007/s00101-024-01481-7. Epub 2024 Nov 22.

DOI:10.1007/s00101-024-01481-7
PMID:39576320
Abstract

Risk prediction models are an established component of the preoperative evaluation. In its guidelines the European Society for Cardiology proposes several risk scores but the benefit of these is mostly unclear for clinicians. This article describes the individual steps in the preparation of a valid prediction model with a focus on the parameters, discrimination, calibration and external validation. The clinical benefits of the risk scores proposed in the guidelines with respect to these parameters was investigated. All proposed risk scores appear to show a good discrimination in the validation cohorts. Only a few reliable data for a good calibration could be compiled. The external validity of the individual models is unclear. The general benefit of the risk scores cannot be recommended as data for calibration or discrimination in external cohorts are lacking. A precise estimation of the risk cannot be expected.

摘要

风险预测模型是术前评估的既定组成部分。欧洲心脏病学会在其指南中提出了几种风险评分,但这些评分对临床医生的益处大多尚不清楚。本文描述了构建有效预测模型的各个步骤,重点关注参数、区分度、校准和外部验证。研究了指南中提出的风险评分在这些参数方面的临床益处。所有提出的风险评分在验证队列中似乎都显示出良好的区分度。仅能收集到少数关于良好校准的可靠数据。各个模型的外部有效性尚不清楚。由于缺乏外部队列中校准或区分度的数据,风险评分的总体益处无法得到推荐。无法期望对风险进行精确估计。

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本文引用的文献

1
Revised cardiac risk index in predicting cardiovascular complications in patients receiving chronic kidney replacement therapy undergoing elective general surgery.修订的心脏风险指数在预测接受择期普通外科手术的慢性肾脏替代治疗患者心血管并发症中的应用
Perioper Med (Lond). 2024 Jul 10;13(1):70. doi: 10.1186/s13741-024-00429-0.
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GRADE concept paper 8: judging the certainty of discrimination performance estimates of prognostic models in a body of validation studies.GRAD 概念论文 8:判断一组验证研究中预后模型判别性能估计的确定性。
J Clin Epidemiol. 2024 Jun;170:111344. doi: 10.1016/j.jclinepi.2024.111344. Epub 2024 Apr 3.
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External validity of four risk scores predicting 30-day mortality after surgery.
四种预测术后30天死亡率的风险评分的外部效度
BJA Open. 2022 Jun 23;3:100018. doi: 10.1016/j.bjao.2022.100018. eCollection 2022 Sep.
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Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study.使用自我报告的功能能力对非心脏手术后主要不良心血管事件进行风险评估:国际前瞻性队列研究。
Br J Anaesth. 2023 Jun;130(6):655-665. doi: 10.1016/j.bja.2023.02.030. Epub 2023 Apr 1.
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Performance and usability of pre-operative prediction models for 30-day peri-operative mortality risk: a systematic review.术前30天围手术期死亡风险预测模型的性能与可用性:一项系统评价
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Risk Prediction for Complications in Inflammatory Bowel Disease Surgery: External Validation of the American College of Surgeons' National Surgical Quality Improvement Program Surgical Risk Calculator.炎症性肠病手术并发症的风险预测:美国外科医师学会国家外科质量改进计划手术风险计算器的外部验证
J Crohns Colitis. 2023 Jan 27;17(1):73-82. doi: 10.1093/ecco-jcc/jjac114.
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Ockham's razor, not a barber's weapon but a writer's tool.奥卡姆剃刀,不是理发师的武器,而是作家的工具。
Brain. 2022 Jun 30;145(6):1870-1873. doi: 10.1093/brain/awac159.
9
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Vasc Med. 2021 Oct;26(5):535-541. doi: 10.1177/1358863X21996806. Epub 2021 Apr 5.
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External validation of prognostic models: what, why, how, when and where?预后模型的外部验证:是什么、为什么、如何、何时以及何地?
Clin Kidney J. 2020 Nov 24;14(1):49-58. doi: 10.1093/ckj/sfaa188. eCollection 2021 Jan.