天津医药

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SinoSCORE对单中心CABG患者术后早期死亡率及并发症的预测效能分析

白云鹏1,刘建实2,陈庆良3,郭志刚3,姜楠3,王联群2,李培军3   

  1. 1. 天津医科大学研究生院
    2. 天津市胸科医院心外科
    3. 天津市胸科医院
  • 收稿日期:2011-09-14 修回日期:2011-12-30 出版日期:2012-08-15 发布日期:2012-08-15
  • 通讯作者: 刘建实

Analysis the predictive value in early mortality and postoperative complications in patients undergoing coronary artery bypass grafting in a single heart center by SinoSCORE

  • Received:2011-09-14 Revised:2011-12-30 Published:2012-08-15 Online:2012-08-15

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摘要： 目的：应用中国冠状动脉旁路移植手术风险评估系统(SinoSCORE)预测单中心接受冠状动脉旁路移植术（CABG）患者术后早期死亡率及并发症发生率，评价SinoSCORE评分系统的预测效能。方法：收集我科2010年1月—2011年1月施行CABG患者围手术期资料。应用SinoSCORE预测死亡率，通过比较实际死亡率和预期死亡率评价模型的预测能力。运用Hosmer—Lemeshow拟合优度检验评价其校准度，运用ROC曲线下面积（AUC）评价其分辨力。再应用Hosmer—Lemeshow拟合优度和AUC评价SinoSCORE对并发症发生率的预测能力。计算Youden指数得出对应最佳诊断界值（Cut-off值），根据Cut-off值分组，X2检验比较两组实际死亡率和并发症发生率。结果：全组共1103例病人，患者平均年龄（62.8±8.8）岁。全组患者术后30日内22例死亡，实际死亡率1.99%。SinoSCORE预计全组死亡率为3.01%,较实际死亡率略高。利用Hosmer—Lemeshow拟合优度检验评价SinoSCORE的校准度，X2=3.473，P=0.748，P＞0.05，证明SinoSCORE对于术后早期死亡率校准度较好。ROC检验SinoSCORE的分辨力，AUC=0.751＞0.75，证明SinoSCORE对于本组患者的死亡分辨力良好。通过检验SinoSCORE拥有良好预测价值的并发症为：低心排综合征、脑血管事件、多脏器衰竭、气管切开及术中/术后植入IABP。五种并发症Hosmer-Lemeshow拟合优度检验分别为P=0.415、P=0.689、P=0.243、P=0.945、P=0.287。ROC曲线下面积分别为AUC=0.785、AUC=0.745、AUC=0.829、AUC=0.821、AUC=0.757。计算Youden指数得出对应Cut-off值，SinoSCORE对患者术后早期死亡率及预测价值良好的5种并发症的Cut-off值分别为3.5、6.5、5.5、3.5、3.5、5.5。结论：SinoSCORE对本中心接受CABG患者的术后早期死亡率及术后低心排综合征、多脏器衰竭、气管切开及术中/术后植入IABP的预测效能良好。

关键词: 死亡率, SinoSCORE, 危险因素, CABG

Abstract: Objective: To predict the early mortality and postoperative complication in patients undergoing coronary artery bypass grafting（CABG）by SinoSCORE in a single heart center,and access the performance of the SinoSCORE. Methods: To collect the clinical information of patients undergoing CABG in our department. Tne SinoSCORE was used to predict early mortality,access the performance of SinoSCORE predict the early mortality through compare the predictive mortality and the observed mortality.To use Hosmer-Lemeshow goodness-of-fit test access the calibration. Discrimination was tested by determining the area under the receiver operating characteristic(ROC) curve(AUC). To evaluate the performance of SinoSCORE on postoperative complications by AUC and Hosmer-Lemeshow test.The optimal cut—off point for SinoSCORE predicting major complications was obtained by the Yonden index．To used X2 test to Compare incidence rate of postoperative complications in two group divided by cut—off point. Results: The overall mean baseline age was(62.8±8.8)years. The observed mortality in postoperative 30 days of all our study patients was 1.99％(22／1103)．The predictive mortality of SinoSCORE was 3.01%. The predicted mortality calculated by the SinoSCORE was 3.01% which was slightly higher than the actual mortality.To use Hosmer-Lemeshow goodness-of-fit test access the calibration: X2=3.473，P=0.748，P＞0.05.The text Proved SinoSCORE had a good calibration for postoperative early mortality. Discrimination was tested by ROC, AUC=0.751＞0.75，that means SinoSCORE showed high discriminatory ability in predicting mortality.SinoSCORE also showed the good calibration power and vary high discriminatory ability for the main complication risk evaluation such as Low cardiac output syndrome, cerebrovascular events,tracheal incision ,MODS and intraoperative/postoperative IABP implantation. Hosmer-Lemeshow: P=0.415，P=0.689，P=0.243，P=0.945，P=0.287. Areas under ROC curve was AUC=0.785，AUC=0.745，AUC=0.829，AUC=0.821，AUC=0.757.Obtained the optimal Cut-off points by calculating the Youden index. The optimal cut-off points for SinoSCORE model predicting early mortality and the above five major postoperative complication was 3.5，6.5，5.5，3.5，3.5，5.5.Conclusion: SinoSCOBE have a good forecast performance for the postoperative early mortality and some postoperative complication in the patients undergoing CABG in our department.And the postoperative complication include Low cardiac output syndrome,cerebrovascular events, tracheal incision and intraoperative/postoperative IABP implantation.

Key words: Mortality, SinoSCORE, Risk factors, CABG