EuroSCOREⅡ和STS评分在感染性心内膜炎手术治疗中的应用价值
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厦门市科技局医学研究计划项目(3502Z20149019)


Performance of EuroSCORE Ⅱ and STS score in patients with infective endocarditis undergoing cardiac surgery
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    目的:评估欧洲心脏手术风险评估系统(European system for cardiac operative risk evaluation, EuroSCORE)Ⅱ和美国胸外科医师协会(Society of Thoracic Surgeons, STS)评分预测感染性心内膜炎(infective endocarditis, IE)患者手术风险的应用价值。方法:回顾性收集2012年7月—2016年3月厦门大学附属心血管病医院成人IE手术患者的临床资料,进行EuroSCOREⅡ和 STS评分,采用受试者工作特征曲线(receiver-operating characteristic, ROC)和Hosmer-Lemeshow拟合优度检验评价两种评分对预后判断的分辨度和校准度,并根据EuroSCOREⅡ评分将患者分为低危(<3%)、中危(3%~6%)及高危(≥6%)组,比较各组间的预后差异。结果:80例IE手术患者住院期间死亡3例(3.75%),远期随访共死亡6例(7.50%)。EuroSCOREⅡ、STS及联合评分对远期总死亡预测的曲线下面积(area under the curve, AUC)分别为0.836、0.833、0.846,对住院期间死亡预测的AUC分别为0.946、0.980、0.980,Hosmer-Lemeshow拟合优度检验P值均>0.05,提示分辨度和校准度均良好。住院期间高危组预期死亡率与实际死亡率接近(11.8% vs. 10.3%,P=0.358),在低危组和中危组被高估(P<0.01);中危组预期远期总死亡率与实际死亡率接近(4.1% vs. 4.2%,P=0.718),在高危组被低估(11.8% vs. 17.2%,P<0.05),在低危组被高估(1.9% vs. 0,P<0.01)。结论:EuroSCOREⅡ和STS评分对于预测IE手术患者住院期间死亡及远期死亡具有一定价值。

    Abstract:

    Objective: To evaluate the performance of European system for cardiac operative risk evaluation(EuroSCORE)Ⅱ and the Society of Thoracic Surgeons(STS) score in patients with infective endocarditis(IE) undergoing cardiac surgery. Methods: Data were retrospectively collected from adult patients undergoing cardiac surgery for IE between July 2012 and March 2016 in our hospital. EuroSCOREⅡ and STS score were calculated. The discrimination and calibration of these two scoring system were assessed by receiver-operating characteristic(ROC) curve analysis and Hosmer-Lemeshow goodness-of-fit test. According to the EuroSCOREⅡ, patients were divided into the low risk group(<3%), the medium risk group(3%~6%) and the high risk group(≥6%). Differences in prognosis among these three groups were compared. Results: Among 80 IE patients undergoing cardiac surgery, 3 patients(3.75%) died in-hospital and total 6 deaths(7.5%) were observed during follow-up. The area under the ROC curve(AUC) for the EuroSCOREⅡ, STS, and combination of them was 0.836, 0.833, and 0.846 to predict late mortality respectively; 0.946, 0.980, and 0.980 to predict in-hospital mortality respectively, which indicated good discriminative power. Hosmer-Lemeshow goodness-of-fit test showed significant P-values(P>0.05) indicating good calibration and accuracy. The predictive in-hospital mortality was similar to actual mortality in the high risk group(11.8% vs. 10.3%, P=0.358), and significantly higher than that in the low risk and medium groups(P<0.01). The predictive late mortality was similar to actual mortality in the medium risk group(4.1% vs. 4.2%, P=0.718), whereas was underestimated in the high risk group(11.8% vs. 17.2%,P<0.05) and overrated in the low risk group(1.9% vs. 0%,P<0.01). Conclusion: Both EuroSCOREⅡ and STS scoring system can satisfactorily predict in-hospital mortality and late mortality in patients with IE undergoing cardiac surgery.

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孟凡琦,宋世波,林 智,尤 颢,伍 源. EuroSCOREⅡ和STS评分在感染性心内膜炎手术治疗中的应用价值[J].南京医科大学学报(自然科学版),2017,(11):1423-1428

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  • 收稿日期:2017-08-16
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  • 在线发布日期: 2017-12-06
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