摘要目的 评价EuroSCORE和STS-PROM模型对成人主动脉瓣患者手术死亡风险预测的价值.方法 回顾性收集1999年1月至2008年12月521例行主动脉瓣置换术的患者临床资料,包括同期行冠状动脉旁路(CABG)手术患者,排除同期其他瓣膜置换、主动脉手术、先天性心脏病矫治及房颤外科手术治疗患者,年龄＜18岁患儿.以患者住院死亡作为终点事件.利用网页在线计算EuroSCORE和STS-PROM预测的住院病死率,并根据additive EuroSCORE评分结果把患者分为低、中、高3个风险组.通过实际、预测病死率间的比较以及模型符合度、鉴别度的验证来评价各风险模型对患者住院病死率的预测能力.结果 521例主动脉瓣置换患者的实际住院病死率为4％(21/521例).Additive、logistic EuroSCORE和STS-PROM预测住院病死率分别为3.36％、2.82％和1.25％,实际观察值/预测值(O/E)分别为1.20、1.43和3.23.STS-PROM对全部患者和中、高风险组的预测准确性较差,明显低估患者住院病死率(P＜0.01).Logistic EuroSCORE明显低估中风险组患者住院病死率(P＜0.05).Additive和logisticEuroSCORE有低估高风险组患者住院病死率的趋势,实际观察值/预测值分别为1.84和1.46.EuroSCORE在各风险组以及STS-PROM在中、高风险组中均显示出较差的预测鉴别度(ROC ＜0.7).结论 STS-PROM和EuroSCORE对521例主动脉瓣置换患者个体手术死亡风险的预测均较差,不适合被用于筛选主动脉瓣置换术高危患者人群.有必要建立适合我国瓣膜患者特征的手术风险预测模型.

abstractsObjective The aim of the study was to analyze the predictive value of the European system for cardiac operative risk evaluation score (EuroSCORE) and the Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) in -dult patients undergoing aortic valve replacement (AVR).Methods We carried out a retrospective statistical analysis on 521 adult patients undergoing AVR between 1999 and 2008 in Changhai hospital.Patients with concomitant coronary artery bypass grafting were also included.Excluded from this study were patients having surgery for congenital heart defects,aneurysm of thoracic aorta and atrial fibrillation.Operative mortality was defined as death before discharge from the hospital.The mortality risk calculation of EuroSCORE and STS-PROM for aortic valve procedures was performed by the online available EuroSCORE or STS score calculator.Based on the additive EuroSCORE risk calculation,patients were divided into low-risk,medium-risk and high-risk groups.The valuation of three different algorithms depended on the assessment of two features:calibration and discrimination.A comparison of observed and predicted mortality rates was also performed.Results A total of 521 patients were identified as having undergone aortic valve replacement.In-hospital mortality was 4％ (21 cases) overall.The expected mortality for the additive,logistic EuroSCORE and the STS-PROM was 3.36％,2.82％ and 1.25％,respectively.The observed to expected ratio was 1.2 for additive EuroSCORE,1.43 for logistic EuroSCORE and 3.23 for STS-PROM.The STS-PROM underpredicted observed mortality significantly ( P ＜ 0.01 ) and showed poor calibration in predicting in-hospital mortality in the entire cohort,medium- and high-risk subgroups.The logistic EuroSCORE underpredicted observed mortality in the mediumrisk subgroup ( P ＜ 0.05 ).EuroSCORE underpredicted in-hospital mortality in the high-risk subgroup with the observed-expected mortality rate of 1.84 for additive EuroSCORE and 1.46 for logistic EuroSCORE.The EuroSCORE in three subgroups showed poor discrimination in predicting mortality as well as the STS-PROM did in the medium- and high-risk subgroups ( ROC ＜ 0.7).Conclusion Both the EuroSCORE and the STS-PROM give an imprecise prediction for individual operative risk in patients undergoing aortic valve replacement in our study.These algorithms seem unsuitable to identify a high-risk patient population undergoing isolated AVR.It is necessary to construct a risk stratification model for valve surgery according to the profiles of Chinese patients.