SinoSCORE预测瓣膜手术死亡风险

SinoSCORE can predict the early mortality of patients with valve surgery

目的 验证中国冠状动脉旁路移植手术风险评分系统（SinoSCORE）对我国单纯瓣膜手术病人早期病死率的预测价值.方法 回顾性分析我国43家心脏中心2007年1月至2008年12月共13 353例单纯瓣膜手术成年病人临床资料,根据SinoSCORE评分法则对所有病人进行评分.应用接受者工作曲线（ROC）下面积（AUC）检验模型对术后早期死亡的区分度,采用Hosmer-Lemeshow（HL）拟合优度检验验证模型对术后早期死亡的校准度.结果 病人平均年龄（48.0±11.7）岁,男病人5687例（42.0%）.其中行主动脉瓣手术2505例,二尖瓣手术6996例,双瓣手术（二尖瓣联合主动脉瓣手术）4002例.模型ROC曲线下面积为0.74（95%置信区间0.70～0.78）,提示SinoSCORE能较好的区分高危和低危病人,HL拟合优度检验显示模型能准确预测单纯瓣膜手术早期病死率（P=0.47）.结论 SinoSCORE能较准确预测单纯瓣膜手术病人早期病死率,SinoSCORE可用于此类病人风险评估.

Objective To validate the predictive value of SinoSCORE in patients undergoing valve surgery. Methods The clinical data of 13 ±353 patients undergone valve surgery from 43 Chinese cardiac centers between January 2007 and December 2008 were retrospectively analyzed. The score values of all patients were calculated according to the SinoSCORE model.The calibration was tested by the Hosmer-Lemeshow goodness-of-fit statistic. Area under the receiver operator curves （ ROC ）was calculated to evaluate the model＇ s discriminatory ability. Results The mean age of the total patients was （48.0 ± 11.7 ）years. Most of the patients were women （58% versus 42% ）. The data contained 2505 cases of aortic valve surgery, 6996 cases of mitral valve surgery and 4002 cases of double valve surgery （ concomitant aortic and mitral valve surgery）. The area under the ROC （0.74,95% confidence interval 0.70 -0.78 ） revealed that the SinoSCORE possessed strong discriminatory power between high- and low risk patients. The Hosmer-Lemeshow goodness-of-fit test （P = 0.47 ） validated the good predictive ability of SinoSCORE. Conclusion SinoSCORE can accurately predict the early mortality in patients with valve surgery. It is a good and well-validated risk stratification model applicable to patients with valve surgery.