天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (7): 700-707.doi: 10.11958/20171189

• 临床研究 • 上一篇    下一篇

EuroSCORE Ⅱ和SinoSCORE在单中心冠脉搭桥术中 预测效能的分析

李开涛 1，白云鹏 2△，郭志刚 2   

  1. 1天津市急救中心（邮编300041）；2天津市胸科医院心外科
  • 收稿日期:2017-10-30 修回日期:2018-04-03 出版日期:2018-07-15 发布日期:2018-07-15
  • 通讯作者: 王联群 E-mail:lianqun1964@hotmail.com
  • 作者简介:李开涛（1977），男，学士学位，主治医师，主要从事心脑血管疾病的急救工作
  • 基金资助:
    AGEs-RAGE系统在主动脉瓣钙化中的调控机制

Analysis of predictive efficacy of EuroSCORE Ⅱ and SinoSCORE for patients undergoing coronary bypass surgery in single center

LI Kai-tao1, BAI Yun-peng2△, GUO Zhi-gang2   

  1. 1 Tianjin Emergency Medical Center, Tianjin 300041, China; 2 Department of Cardiac Surgery, Tianjin Chest Hospital △Corresponding Author E-mail: oliverwhite@126.com
  • Received:2017-10-30 Revised:2018-04-03 Published:2018-07-15 Online:2018-07-15
  • Contact: Lianqun Wang E-mail:lianqun1964@hotmail.com

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摘要： 目的 检验比较EuroSCORE Ⅱ和SinoSCORE对中国冠状动脉旁路移植术（CABG）患者术后院内病死率的 预测效能。方法 回顾性分析2011年1月—2015年4月本中心4 507例行CABG患者的临床资料。利用EuroSCORE Ⅱ和SinoSCORE对患者进行心血管风险分层（按照预测病死率分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组），并分别预测全组和各亚组患者 病死率。预测效能通过辨别力和校准力分析评判。结果 全组患者院内病死率为1.35%，EuroSCORE Ⅱ平均预测病 死率为 1.47%（95%CI：1.43~1.50），SinoSCORE 平均预测病死率为 2.86%（95% CI：2.76~2.96）；EuroSCORE Ⅱ和 SinoSCORE ROC曲线下面积（AUC）分别为0.728和0.716；用Hosmer-Lemeshow拟合优度检验发现EuroSCORE Ⅱ校 准度较差，而 SinoSCORE 校准度尚可。EuroSCORE Ⅱ低估了Ⅳ组患者病死率，但高估了其他组患者的病死率； SinoSCORE 低估了Ⅰ组患者病死率，但高估了其他组患者的病死率。EuroSCORE Ⅱ对Ⅰ组患者有较好的辨别力 （AUC=0.707），SinoSCORE对Ⅱ组患者有较好的辨别力（AUC=0.754）。EuroSCORE Ⅱ略高估单一行CABG手术患者 的病死率而低估合并其他心脏手术患者的病死率；SinoSCORE高估2组患者的病死率。EuroSCORE Ⅱ和SinoSCORE 对单一行CABG手术患者AUC分别为0.694和0.687，对CABG合并其他心脏手术患者AUC 分别为0.772和0.669。结 论 EuroSCORE Ⅱ在全组和Ⅰ、Ⅱ、Ⅲ组患者中能有好的预测效能，但低估Ⅳ组患者病死率；SinoSCORE高估全组和 Ⅱ、Ⅲ、Ⅳ组患者病死率，低估了Ⅰ组患者病死率。风险评估模型的应用和建立应着眼于不同心脏疾病及不同风险 层次，风险评估模型的建模方法有待改善。

关键词: EuroSCORE Ⅱ, SinoSCORE, 风险评分系统, 冠状动脉旁路移植术

Abstract: Objective To compare the predictive efficacy of EuroSCORE Ⅱ and SinoSCORE in the postoperative mortality of Chinese patients underwent coronary artery bypass grafting (CABG). Methods The clinical data of 4 507 patients with CABG at our department in January 2011 and April 2015 were retrospectively analyzed. Cardiovascular risk stratification was performed on patients using EuroSCORE Ⅱ and SinoSCORE. Patients were divided into Ⅰ, Ⅱ, Ⅲ and Ⅳ groups according to the predicted fatality rates. The mortality rates were predicted in all groups of patients respectively. Predictive effectiveness was analyzed by the analysis of discernment and calibration force. Results The in-hospital mortality rate was 1.35% in all patients, while the mean mortality rate predicted by EuroSCORE Ⅱ was 1.470%±1.215% (95%CI：1.43-1.50), and predicted by SinoSCORE was 2.860% ± 3.454% (95% CI：2.76-2.96). The AUC values of EuroSCORE Ⅱ and SinoSCORE were 0.728 and 0.716. It was found that the calibration degree of EuroSCORE Ⅱ was poor and SinoSCORE was acceptable detected by Hosmer-Lemeshow Test. EuroSCORE Ⅱ underestimated the mortality rates of group Ⅳ, but overestimated mortality rates in other groups of patients. SinoSCORE underestimated mortality rates of patients in group Ⅰ and overestimated mortality rates in other groups of patients. EuroSCORE Ⅱ only achieved good discrimination for patients of group Ⅰ (AUC=0.707), and SinoSCORE achieved good discrimination for patients of group Ⅱ (AUC= 0.754) EuroSCORE Ⅱ overestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries. SinoSCORE overestimated mortality rates in group Ⅱ. The AUC values of EuroSCORE Ⅱ and SinoSCORE were 0.694 and 0.687 in isolated CABG group. The AUC values of EuroSCORE Ⅱ and SinoSCORE were 0.772 and 0.669 in CABG combined with other cardiac surgeries. Conclusion EuroSCORE Ⅱ has a good predictive efficacy in the entire group of patients and Ⅰ, Ⅱ and Ⅲ groups, but has a poor performance in group Ⅳ. SinoSCORE overestimates mortality rates in the entire group and Ⅰ, Ⅱ and Ⅲ groups, and it underestimates mortality rates in patients of group Ⅰ. The application and establishment of risk models should focus on different heart diseases and different risk levels, and the modeling method of established risk systems needs to be improved.

Key words: EuroSCORE Ⅱ, SinoSCORE, risk models, coronary artery bypass graft