EuroSCORE Ⅱ和SinoSCORE在单中心冠脉搭桥术中预测效能的分析

Analysis of predictive efficacy of EuroSCORE Ⅱ and SinoSCORE for patients undergoing coronary bypass surgery in single center

目的检验比较EuroSCORE Ⅱ和Sino SCORE对中国冠状动脉旁路移植术(CABG)患者术后院内病死率的预测效能。方法回顾性分析2011年1月—2015年4月本中心4 507例行CABG患者的临床资料。利用EuroSCORE Ⅱ和Sino SCORE对患者进行心血管风险分层(按照预测病死率分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组),并分别预测全组和各亚组患者病死率。预测效能通过辨别力和校准力分析评判。结果全组患者院内病死率为1.35%,EuroSCORE Ⅱ平均预测病死率为1.47%(95%CI:1.43~1.50),Sino SCORE平均预测病死率为2.86%(95%CI:2.76~2.96);EuroSCORE Ⅱ和Sino SCORE ROC曲线下面积(AUC)分别为0.728和0.716;用Hosmer-Lemeshow拟合优度检验发现EuroSCORE Ⅱ校准度较差,而Sino SCORE校准度尚可。EuroSCORE Ⅱ低估了Ⅳ组患者病死率,但高估了其他组患者的病死率;Sino SCORE低估了Ⅰ组患者病死率,但高估了其他组患者的病死率。EuroSCORE Ⅱ对Ⅰ组患者有较好的辨别力(AUC=0.707),Sino SCORE对Ⅱ组患者有较好的辨别力(AUC=0.754)。EuroSCORE Ⅱ略高估单一行CABG手术患者的病死率而低估合并其他心脏手术患者的病死率;Sino SCORE高估2组患者的病死率。EuroSCORE Ⅱ和Sino SCORE对单一行CABG手术患者AUC分别为0.694和0.687,对CABG合并其他心脏手术患者AUC分别为0.772和0.669。结论 EuroSCORE Ⅱ在全组和Ⅰ、Ⅱ、Ⅲ组患者中能有好的预测效能,但低估Ⅳ组患者病死率;Sino SCORE高估全组和Ⅱ、Ⅲ、Ⅳ组患者病死率,低估了Ⅰ组患者病死率。风险评估模型的应用和建立应着眼于不同心脏疾病及不同风险层次,风险评估模型的建模方法有待改善。

Objective To compare the predictive efficacy of EuroSCOREⅡand SinoSCORE in the postoperative mortality of Chinese patients underwent coronary artery bypass grafting(CABG).Methods The clinical data of 4 507 patients with CABG at our department in January 2011 and April 2015 were retrospectively analyzed.Cardiovascular risk stratification was performed on patients using EuroSCOREⅡand SinoSCORE.Patients were divided intoⅠ,Ⅱ,ⅢandⅣgroups according to the predicted fatality rates.The mortality rates were predicted in all groups of patients respectively.Predictive effectiveness was analyzed by the analysis of discernment and calibration force.Results The in-hospital mortality rate was 1.35%in all patients,while the mean mortality rate predicted by EuroSCOREⅡwas 1.470%±1.215%(95%CI:1.43-1.50),and predicted by SinoSCORE was 2.860%±3.454%(95%CI:2.76-2.96).The AUC values of EuroSCOREⅡand SinoSCORE were 0.728 and 0.716.It was found that the calibration degree of EuroSCOREⅡwas poor and SinoSCORE was acceptable detected by Hosmer-Lemeshow Test.EuroSCOREⅡunderestimated the mortality rates of groupⅣ,but overestimated mortality rates in other groups of patients.SinoSCORE underestimated mortality rates of patients in groupⅠand overestimated mortality rates in other groups of patients.EuroSCOREⅡonly achieved good discrimination for patients of groupⅠ(AUC=0.707),and SinoSCORE achieved good discrimination for patients of groupⅡ(AUC=0.754).EuroSCOREⅡoverestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries.SinoSCORE overestimated mortality rates in groupⅡ.The AUC values of EuroSCOREⅡand SinoSCORE were 0.694 and 0.687 in isolated CABG group.The AUC values of EuroSCOREⅡand SinoSCORE were 0.772 and 0.669 in CABG combined with other cardiac surgeries.Conclusion EuroSCOREⅡhas a good predictive efficacy in the entire group of patients andⅠ,ⅡandⅢgroups,but has a poor performance in groupⅣ.SinoSCORE overestimates mortality rates in the entire group andⅠ,ⅡandⅢgroups,and it underestimates mortality rates in patients of groupⅠ.The application and establishment of risk models should focus on different heart diseases and different risk levels,and the modeling method of established risk systems needs to be improved.