SinoSCORE预测瓣膜手术在院死亡风险——第二军医大学长海医院胸心外科经验

Validation of the Chinese System for Cardiac Operative Risk Evaluation （SinoSCORE）in Chinese heart valve surgery： the experience from department of cardiothoracic surgery of Changhai Hospital

目的评价中国冠状动脉旁路移植手术死亡风险评分系统（SinoSCORE）对成人瓣膜手术患者在院病死率预测的准确性。方法回顾性收集2009年1月至2011年12月2098例因瓣膜疾病行外科治疗成人患者（年龄≥16岁）的临床资料，按SinoSCORE系统评分，分低、中、高3风险组，最后将全组及各风险组患者的实际病死率与预测病死率进行对比。模型预测的符合程度应用H-L卡方检验，预测的鉴别效度则通过ROC曲线下面积反映。结果2098例患者在院死亡63例，实际在院病死率3．00％。虽然SinoSCORE数据库患者术前各危险因素的分布与本组患者有着明显差别，但SinoSCORE评分方法对本组患者术后在院死亡的预测仍具有较高的准确性（H．L检验P=0．783）；同时，该评分方法预测的鉴别效度也较高（ROC曲线下面积0．752）。其能够准确预测患者手术后是否发生在院死亡。结论SinoSCORE评分方法虽为中国冠状动脉旁路移植手术死亡风险评分系统，但其对瓣膜手术患者的在院死亡风险预测也具有较好的准确性。

Objective To assess the Chinese System for Cardiac Operative Risk Evaluation （SinoSCORE） model in pa- tients undergoing heart valve surgery at our center. Methods From January 2009 to December 2011, 2098 consecutive adult patients who underwent heart valve surgery at our center were collected and scored according to the SinoSCORE model. All pa- tients were divided into three risk subgroups. The entire cohort and each risk subgroup were analysed. Calibration of the Si- noSCORE model was assessed by the Hosmer-Lemeshow （H-L） test. Discrimination was tested by calculating the area under the receiver operating characteristic （ROC） curve. Results Observed mortality of all 2098 patients was 3.00%. Despite there were significant differences between the SinoSCORE population and our own population sample, the SinoSCORE model showed good calibration （ Hosmer-Lemeshow ： P = 0. 783 ） and discriminative power （ area under the ROC curve of 0. 752） in predicting in-hospital mortality at the entire cohort. Conclusion The SinoSCORE model give an accurate prediction for individual opera- tive risk in heart valve surgery patients at our center.