Logistic EuroSCORE与EuroSCORE Ⅱ风险评分系统对冠状动脉旁路移植术后死亡风险预测的比较

Comparison of Logistic EuroSCORE and EuroSCORE Ⅱ in Patients Undergoing Coronary Artery Bypass Surgery

目的对比分析LogisticEuroSCORE与EuroSCOREⅡ风险评分系统对冠状动脉旁路移植术后住院死亡风险预测的价值。方法回顾性收集2012年1月～2013年12月在笔者医院行单纯冠状动脉旁路移植术的568例患者，分别用LogisticEu—roSCORE与EuroSCOREⅡ计算患者的预测病死率，再与患者的实际住院病死率进行对比。使用Hosmer—Lemeshow拟和优度检验评价评分系统的校准度，使用受试者工作特征曲线（receiveroperatingcharacteristic，ROC）下面积（areaundercurve，RUC）评价评分系统的区分度。结果568例患者住院死亡5例，实际住院病死率0．88％，LogisticEuroSCORE预测病死率5．37％，EuroSCOREⅡ预测病死率1，53％。LogisticEuroSCORE明显高估了住院病死率，EuroSCOREⅡ的预测值与实际住院病死率接近。LogisticEu—roSCORE的Hosmer—Lemeshow拟和优度检验P=0．692，AUC=0．635；EuroSCOREⅡ的Hosmer—Lemeshow拟和优度检验P=0．993，AUC=0．758。LogisticEuroSCORE的区分度差，EuroSCOREⅡ区分度及校准度均较好。结论EuroSCOREⅡ较适用于预测本中心冠脉旁路移植患者的住院死亡风险。

Objective To compare the predictive value of Logistic EuroSCORE and EuroSCORE Ⅱ in patients undergoing coronary artery bypass surgery. Methods The clinical data of 568 patients underwent coronary artery bypass surgery between January 2012 to De- cember 2013 in our department was retrospectively analyzed. Predicted mortality calculated by Logistic EuroSCORE and EoroSCORE Ⅱ was compared with observed in- hospital mortality. Calibration and discrimination was evaluated by Hosmer - Lemeshow（HL） goodness- of- fit test and the area under the receiver operating characteristic （ROC） curve, respectively. Results 5 of 568 patients died in hospi- tal and the observed mortality was O. 88%. The predictive mortality calculated by Logistic EuroSCORE and EuroSCORE Ⅱ was 5.37% and 1.53% , respectively. Logistic EuroSCORE overestimated the in- hospital mortality and EuroSCORE U forecast a similar mortality compared with observed one. For Logistic EuroSCORE the HL test was non - significant（P = 0. 692） and the area under ROC curve was 0. 635. For EuroSCORE Ⅱ the HL test was non - significant（P = 0. 993 ） and the area under ROC curve was 0. 758. The discrimination of Logistic EuroSCORE was bad. EuroSCORE Ⅱ shows good calibration and discrimination. Conclusion The EuroSCORE Ⅱ was suitable in predicting the mortality of CABG patients in our department.