比较additive EuroSCORE,logistic EuroSCORE,EuroSCORE Ⅱ风险评分系统在评估中国心脏外科手术患者中的应用  

Comparison of additive EuroSCORE, logistic EuroSCORE, EuroSCORE Ⅱ risk models in application of evaluation of China cardiac surgical patients

作　　者：江慧琦[1] 王萌[1] 张书铭[1] 曾宽[1] 胡海宇[1] 华平[1] 杨艳旗[1] 

机构地区：[1]中山大学孙逸仙纪念医院心胸外科,广州510120

出　　处：《岭南现代临床外科》2013年第6期485-489,共5页Lingnan Modern Clinics in Surgery

基　　金：广东省科技计划项目(2012B03180025)

摘　　要：目的 评价additive EuroSCORE,logistic EuroSCORE及EuroSCOREⅡ风险评分系统在预测中国心脏外科患者行心脏手术住院死亡率准确性中的作用.方法 回顾性收集中山大学孙逸仙纪念医院心胸外科于2006年1月至2012年10月接受心脏手术的594例成人患者的临床资料,其中男348例,女246例;平均年龄57.59±14.27岁.分别按additive EuroSCORE,logisticEuroSCORE及EuroSCOREⅡ计算每例患者的预测死亡率,按预测死亡率把患者分6组（Ⅰ组0～1.99％,Ⅱ组2％～3.99％,Ⅲ组4％～5.99％,Ⅳ组6％～7.99％,V组8％～9.99％,Ⅵ组大于10％）,比较每组实际住院死亡率与预测死亡率.预测模型的区分度使用受试者工作特征（receiveroperating characteristic,ROC）曲线下面积进行检验,校准度使用Hosmer-Lemeshow拟和优度检验.结果 594例患者住院死亡31例,实际住院死亡率5.22％,additive EuroSCORE预测死亡率3.46％±2.62％,logistic EuroSCORE预测死亡率3.61％±4.32％,EuroSCOREⅡ预测死亡率2.81％±4.26％.EuroSCOREⅡ低估了Ⅱ、Ⅳ、Ⅴ组住院死亡率,但在其余各组中均较好预测住院死亡率.EuroSCOREⅡ较additive/logistic EuroSCORE区分度好（AUC 0.727 vs.0.704,0.715）,除logisticEuroSCORE的Hosmer-Lemeshow拟和优度检验（P＜0.05）外其余两种方法校准度均较好（P＞0.05）.结论 EuroSCOREⅡ评分系统较适用于预测本中心心脏手术患者的住院死亡风险.Objective To evaluate the accuracy of additive EuroSCORE, logistic EuroSCORE and EuroSCORE I1 in predicting the resident mortality of cardiac surgery. Methods Between January 2006 and October 2012, the clinical data of 594 patients in eardiothoraeic surgery department, Sun Yat-sen Memorial Hospital, were retrospectively collected. The cohort was composed of 348 male and 246 female patients and the average age was 57.59＋14.27 years. The expected mortality rate was calculated by additive EuroSCORE, logistic EuroSCORE and EuroSCORE 11 retrospectively. According to the expected mortality, all the patients were divided into 6 groups （Group I 0-1.99%, Group I1 2% -3.99%, Groupm 4%-5.99%, GrouplV 6%-7.99%, GroupV 8%-9.99%, GroupVI 〉10%）. The observed and expected mortality of each group was compared. Calibration and discrimination were assessed using the Hosmer-Lemeshow （HL） Chi-square test and areas under the receiver operating characteristic （ROC） curve. Results The total observed mortality was 5.22% （31/594）. The expected mortality was 3.46%~2.62% by additive EuroSCORE, 3.61%~4.32% by the logistic EuroSCORE and 2.81%＋4.26% by EuroSCORE 1I. EuroSCORE II predicted the resident hospital mortality well except in group I and II in which the mortality was underestimated. EuroSCORE II had better discrimination than additive/logistic EuroSCORE （AUC 0.727 vs. 0.704, 0.715）. P〈0.05 for HL test of the logistic EuroSCORE while the other two systems had a good calibration. Conclusion EuroSCORE I1 system is appropriate for predicting the mortality of patients in our heart center.

关 键 词：心脏手术 ADDITIVE EUROSCORE LOGISTIC EUROSCORE EuroSCOREⅡ 风险预测 住院死亡率 

分 类 号：R654.2[医药卫生—外科学]