Mortality risk prediction in cardiac surgery: comparing a novel model with the EuroSCORE

被引:13
作者
Berg, K. S. [2 ]
Stenseth, R. [3 ,4 ]
Pleym, H. [3 ,4 ]
Wahba, A. [3 ,5 ]
Videm, V. [1 ,2 ]
机构
[1] St Olavs Univ Hosp, Dept Immunol & Transfus Med, NO-7006 Trondheim, Norway
[2] Norwegian Univ Sci & Technol, Dept Lab Med Childrens andWomens Hlth, N-7034 Trondheim, Norway
[3] Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway
[4] St Olavs Univ Hosp, Dept Cardiothorac Anaesthesia & Intens Care, NO-7006 Trondheim, Norway
[5] St Olavs Univ Hosp, Dept Cardiothorac Surg, NO-7006 Trondheim, Norway
关键词
HEART-SURGERY; STRATIFICATION; SYSTEM;
D O I
10.1111/j.1399-6576.2010.02393.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background Several models for prediction of early mortality after open-heart surgery have been developed. Our objectives were to develop a local mortality risk prediction model, compare it with the European System for Cardiac Operative Risk Evaluation (EuroSCORE), and investigate whether the addition of intra-operative variables could enhance the accuracy of risk prediction. Methods All 5029 patients undergoing open-heart surgery in 2000-2007 were included in the study. Logistic regression with bootstrap methods was used to develop a pre-operative risk prediction model for in-hospital mortality. Next, several intra-operative variables were added to the pre-operative model. Calibration and discrimination were assessed, and the model was internally validated for prediction in future datasets. We thereafter compared the pre-operative model with the additive and logistic EuroSCOREs. Results Our pre-operative model included eight risk factors that are routinely registered in our department: age, gender, degree of urgency, operation type, previous cardiac surgery, and renal, cardiac, and pulmonary dysfunction. The model estimated mortality accurately throughout the dataset except in the 1% of patients at extremely high risk, in which mortality was somewhat overestimated. The estimated shrinkage factor was 0.930. The areas under the receiver operating characteristic curve for our pre-operative model and the logistic EuroSCORE were 0.857(0.823-0.891) and 0.821(0.785-0.857) (P=0.02). There was no significant difference in performance between the pre-operative and the intra-operative model (P > 0.10). Conclusion Our pre-operative model was simple and easy to use, and showed good predictive ability in our population. Internal validation indicated that it would accurately predict mortality in a future dataset.
引用
收藏
页码:313 / 321
页数:9
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