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心脏导管插入术成年患者中CRISP修饰符的应用:单中心经验

Use of CRISP Modifiers for Adults Undergoing Cardiac Catheterization Procedures: A Single Center Experience.

作者信息

Reynolds Kathryn P, Mejia Ernesto, Soszyn Natalie, Morgan Gareth, Zablah Jenny E

机构信息

Heart Institute, Children's Hospital of Colorado, University of Colorado, Aurora, CO, USA.

出版信息

Pediatr Cardiol. 2024 Dec 19. doi: 10.1007/s00246-024-03728-x.

DOI:10.1007/s00246-024-03728-x
PMID:39702852
Abstract

The Catheterization RISk Score for Pediatrics (CRISP) has been validated and widely adopted as a model to predict adverse outcomes. We sought to determine if the addition of three modifiers (NYHA Class > 2, prior sternotomies > 2, and BMI > 30) to the CRISP score would better predict adverse events (AE) in adults undergoing cardiac catheterization at our institution. All adults (> 18 years) who underwent cardiac catheterization at the Children's Hospital Colorado from November 2016 to November 2021 were included. Baseline and modified CRISP scores with adult modifiers and AEs were analyzed. Of a total of 401 cases, there were 27 AEs (6.7%). A higher CRISP score was associated with an increased risk of AEs (p = 0.004). A ROC analysis of the CRISP score gave a AUC of 66% with a cut-off point of 5.5 giving a sensitivity of 74% and specificity of 52%. The modifiers individually did not significantly correlate with AEs. Higher modified CRISP score was similarly associated with an increased risk of AEs (p = 0.01). ROC analysis for the modified CRISP score gave an AUC of 64%. A cut-off point of 6.5 gave the best result with a sensitivity of 59% and specificity of 61%. A modified CRISP score which included adult modifiers similarly predicts AEs in adults with congenital heart disease. These adult modifiers are easy to incorporate into the CRISP score. The CRISP score also predicted AEs in adults with congenital heart disease.

摘要

儿科导管插入术风险评分(CRISP)已得到验证,并作为一种预测不良结局的模型被广泛采用。我们试图确定在CRISP评分中加入三个修正因素(纽约心脏协会(NYHA)心功能分级>2级、既往胸骨切开术次数>2次和体重指数(BMI)>30)是否能更好地预测在我们机构接受心导管插入术的成人患者的不良事件(AE)。纳入了2016年11月至2021年11月在科罗拉多州儿童医院接受心导管插入术的所有成人(>18岁)患者。分析了带有成人修正因素和不良事件的基线CRISP评分及修正后的CRISP评分。在总共401例病例中,有27例不良事件(6.7%)。较高的CRISP评分与不良事件风险增加相关(p = 0.004)。CRISP评分的ROC分析得出曲线下面积(AUC)为66%,截断点为5.5,灵敏度为74%,特异度为52%。这些修正因素各自与不良事件无显著相关性。较高的修正后CRISP评分同样与不良事件风险增加相关(p = 0.01)。修正后CRISP评分的ROC分析得出AUC为64%。截断点为6.5时结果最佳,灵敏度为59%,特异度为61%。包含成人修正因素的修正后CRISP评分同样能预测先天性心脏病成人患者的不良事件。这些成人修正因素很容易纳入CRISP评分。CRISP评分也能预测先天性心脏病成人患者的不良事件。

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本文引用的文献

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Procedural Risk in Congenital Cardiac Catheterization (PREDICT).先天性心脏导管插入术的程序风险(PREDICT)。
J Am Heart Assoc. 2022 Jan 4;11(1):e022832. doi: 10.1161/JAHA.121.022832. Epub 2021 Dec 22.
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Complete Atrioventricular Septal Defects after the Age of 40 Years.40岁之后的完全性房室间隔缺损
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Age- and Lesion-Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population-Based Study.美国先天性心脏病成人的年龄和病变相关合并症负担:一项基于人群的研究。
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A Model for Assessment of Catheterization Risk in Adults With Congenital Heart Disease.成人先天性心脏病患者导管插入术风险评估模型。
Am J Cardiol. 2019 May 1;123(9):1527-1531. doi: 10.1016/j.amjcard.2019.01.042. Epub 2019 Feb 8.
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Validation and refinement of the catheterization RISk score for pediatrics (CRISP score): An analysis from the congenital cardiac interventional study consortium.验证和改进小儿经导管介入治疗风险评分(CRISP 评分):先天性心脏病介入研究联盟的分析。
Catheter Cardiovasc Interv. 2019 Jan 1;93(1):97-104. doi: 10.1002/ccd.27837. Epub 2018 Sep 9.
6
Post-operative Catheterization Interventions at the Site of Surgery: An Application of the CRISP Scoring System.手术部位术后导尿干预:CRISP评分系统的应用
Pediatr Cardiol. 2018 Apr;39(4):674-681. doi: 10.1007/s00246-018-1805-z. Epub 2018 Jan 12.
7
CRISP: Catheterization RISk score for Pediatrics: A Report from the Congenital Cardiac Interventional Study Consortium (CCISC).CRISP:儿科导管插入术风险评分:先天性心脏介入研究联盟(CCISC)的报告。
Catheter Cardiovasc Interv. 2016 Feb 1;87(2):302-9. doi: 10.1002/ccd.26300. Epub 2015 Nov 3.
8
Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM).先天性心脏病经导管介入治疗风险调整方法(CHARM)。
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