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ABSTRACT: BACKGROUND: To compare six risk scores with regard to their validity to predict in-hospital mortality after heart valve surgery in a single-centre patient population of China. METHODS: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the EuroSCORE II, VA risk score, NNE risk score, Ambler risk score, NYC risk score, and STS risk score. Calibration of the six risk scores 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 was 3.32% overall. The STS score showed good calibration in predicting in-hospital mortality (H-L: P=0.126). The EuroSCORE II, VA score, NNE score, and NYC score underpredicted observed mortality (H-L: P<0.0001, P<0.0001, P=0.001, and P<0.0001, respectively) and the Ambler score overpredicted observed mortality (H-L: P=0.005). The discriminative power (i.e. the area under the ROC curve) for in-hospital mortality was highest for the STS score (0.706), followed by the EuroSCORE II model (0.693), NNE score (0.684), NYC score (0.682), Ambler score (0.677) and VA score (0.643). CONCLUSION: Compared with the EuroSCORE II, VA score, NNE score, NYC score, and the Ambler score, the STS score gives an accurate prediction for individual operative risk in patients undergoing heart valve surgery at our centre. Therefore, the use of the STS score for risk evaluation maybe suitable in patients undergoing heart valve surgery at our centre in the future.
Heart Lung & Circulation 04/2013; · 1.20 Impact Factor
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ABSTRACT: BACKGROUND: To assess the performance of the The European System for Cardiac Operative. Risk Evaluation II (EuroSCORE II) in Chinese patients undergoing heart valve surgery at our centre. METHODS: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the original EuroSCORE and EuroSCORE II model. All patients were divided into single valve surgery and multiple valve surgery subgroup. The entire cohort and each subgroup were analysed. Calibration of the original EuroSCORE and EuroSCORE II 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 was 3.32% overall, compared to expected mortality 3.84% for the original additive EuroSCORE (H-L: P=0.013), 3.33% for the original logistic EuroSCORE (H-L: P=0.08), and 2.52% for the EuroSCORE II (H-L: P<0.0001). The EuroSCORE II model showed good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H-L: P=0.103) and poor calibration for patients undergoing multiple valve surgery (H-L: P<0.0001). The discriminative power of the original EuroSCORE model (area under the ROC curve of 0.684 and 0.673 for the additive and logistic model, respectively) and EuroSCORE II model (area under the ROC curve of 0.685) for the entire cohort was poor. The discriminative power of the EuroSCORE II model was good for the single valve surgery group (area under the ROC curve of 0.792) and was poor for the multiple valve surgery group (area under the ROC curve of 0.605). CONCLUSION: The EuroSCORE II model give an accurate prediction for individual operative risk in patients undergoing single valve surgery but an imprecise prediction in patients undergoing multiple valve surgery at our centre. Therefore, the use of the EuroSCORE II model for risk evaluation maybe suitable in patients undergoing single valve surgery, and creation of a new model which accurately predicts outcomes in patients undergoing multiple valve surgery is maybe required at our centre in the future.
Heart Lung & Circulation 01/2013; · 1.20 Impact Factor
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ABSTRACT: BACKGROUNDAND AIMOFTHE STUDY: The aim of this study was to develop a logistic risk prediction model for prolonged ventilation after adult heart valve surgery. MATERIALSAND METHODS: This is a retrospective observational study of collected data on 3965 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n = 2400) and a validation dataset (n = 1565). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for prolonged ventilation (defined as ventilation greater than 72 h). Performance of the model was then assessed by observed and expected rates of prolonged ventilation on the development and validation dataset. Model calibration and discriminatory ability were analyzed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. RESULTS: There were 303 patients that required prolonged ventilation (7.6%). Preoperative independent predictors of prolonged ventilation are shown with odds ratio and P value as follows: (1) age, 1.9, P < .0001; (2) hypercholesterolemia, 5.3, P = .001; (3) renal failure, 18.2, P = .004; (4) previous cardiac surgery, 2.4, P = .0002; (5) left bundle branch block, 4.2, P = .011; (6) ejection fraction, 1.4, P = .003; (7) left ventricle weight, 1.5, P = .007; (8) New York Heart Association class III-IV, 1.8, P = .021; (9) critical preoperative state, 4.5, P < .0001; (10) tricuspid insufficiency, 1.2, P = .031; (11) concurrent CABG, 2.2, P = .019; and (12) concurrent other cardiac surgery, 2.1, P = .001. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P = .202 vs P = .291). The ROC curve for the prediction of prolonged ventilation in development and validation dataset was .789 and .710, respectively. CONCLUSIONS: We developed and validated a local risk prediction model for prolonged ventilation after adult heart valve surgery. This model can be used to calculate patient-specific risk by the logistic equation with an equivalent predicted risk at our center in future clinical practice.
Heart & lung: the journal of critical care 11/2012; · 1.04 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. METHODS: This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n=2401) and a validation dataset (n=1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. RESULTS: There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III-IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P=0.365 vs P=0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. CONCLUSION: We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in future clinical practice.
Heart Lung & Circulation 08/2012; · 1.20 Impact Factor
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ABSTRACT: To explore the clinical effects of alprostadil injection on acute kidney injury (AKI) after cardiac surgical procedures by a prospective randomized controlled trial.
A total of 63 AKI-patients after cardiac surgical procedures were randomly divided into the control group (n = 31) and the study group (n = 32). All patients received routine therapy while patients in the study group were additionally given alprostadil injection (10 µg i.v. once every 12 hours) for 7 days. A 11-year-old patient weighing 29 kg was given half of the conventional dose. During the period of control treatment (7 days), 1 patient in the control group and 2 patients in the study group were excluded because of hemodialysis or peritoneal dialysis. Urine volume, urine β-N-acetylglucosaminidase, urine α(1)-microglobulin, urine β(2)-microglobulin, serum creatinine and blood urea nitrogen were measured before and after the control treatment. And the ICU stay duration and the percentage of dialysis after the control treatment were calculated. Adverse reactions of alprostadil injection were observed simultaneously in the study group.
After the treatment, urine volume in the study group was obviously more than that in the control group [(65.9 ± 3.1) ml/h vs (58.8 ± 4.5) ml/h, P < 0.05] while urine β-N-acetylglucosaminidase, urine α(1)-microglobulin, urine β(2)-microglobulin, serum creatinine and blood urea nitrogen in the study group were obviously lower than those in the control group (all P < 0.05). The ICU stay duration in the study group was obviously less than that in the control group [(12 ± 5) d vs (17 ± 5) d, P < 0.05]. But there was no significant difference in the percentage of dialysis after the control treatment between two groups (3.3% vs 6.7%, P > 0.05). And no serious adverse reaction was reported in the study group.
On the basis of routine therapy, alprostadil injection may promote the recovery of renal function in AKI-patients after cardiac surgical procedures.
Zhonghua yi xue za zhi 08/2010; 90(32):2266-9.
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ABSTRACT: The study aim was to assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in Chinese patients undergoing heart valve surgery.
Between January 2003 and December 2007, the data from a total of 1726 consecutive patients who underwent heart valve surgery at the authors' center were collected and scored according to the additive and logistic EuroSCORE models. The patients were allocated to three risk subgroups, and the entire cohort and each risk subgroup analyzed. Calibration of the EuroSCORE model was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.
Completed data from all 1726 patients were analyzed. There were significant differences in the prevalence of risk factors between the study sample and European cardiac surgery populations. The observed mortality was 4.46% overall, compared to 3.51% (additive) and 2.85% (logistic). The additive EuroSCORE model showed good calibration in predicting in-hospital mortality (H-L; p = 0.204), but the logistic EuroSCORE model underpredicted observed mortality (H-L; p = 0.038) in the entire cohort. Both, the additive and logistic EuroSCORE models showed good calibration in predicting in-hospital mortality in the medium- and high-risk subgroups, but overpredicted observed mortality in the low-risk subgroup. The discriminative power of both models for the entire cohort was poor (areas under the ROC curve of 0.644 and 0.647 for the additive and logistic models, respectively).
The additive and logistic EuroSCORE models gave an imprecise prediction for individual operative risk in heart valve surgery patients at the authors' center; thus, use of the EuroSCORE models for risk evaluation at this center may be unsuitable in the future. It will be necessary to re-examine the performance of the EuroSCORE model for predicting operative mortality in heart valve surgery on a multicenter database in China.
The Journal of heart valve disease 01/2010; 19(1):21-7. · 0.81 Impact Factor
