Role EuroSCORE pro prospektivní odhad krátkodobého rizika u kandidátů pro kardiochirurgickou operaci: Je přesnost EuroSCORE pro odhad perioperačního rizika stejná jako pro odhad rizika nechirurgické léčby?
:
M. Klinčeva 1; P. Widimský 1; A. Dohnalová 2
:
Cardiocenter, University Hospital Královské Vinohrady, Prague, head prof. MUDr. Petr Widimský, DrSc., FESC
1; Institute of Physiology, First Medical faculty of Charles University, Prague, head prof. MUDr. Otomar Kittnar, CSc.
2
:
Vnitř Lék 2006; 52(12): 1156-1161
:
Original Contributions
V éře moderní medicíny je pro praxi kardiochirurga i kardiologa stále důležitější stratifikace perioperačního rizika.
Cíl:
Cílem této studie bylo zhodnocení přesnosti stratifikačního modelu EuroSCORE pro odhad krátkodobé mortality u české populace dospělých pacientů prezentovaných na kardiochirurgickém indikačním semináři.
Metodika:
Studie zahrnuje všechny pacienty (n = 460) prezentované na indikačním semináři jako kardiochirurgické kandidáty během 6měsíčního období. K posouzení rizika byly použity aditivní a logistické EuroSCORE. Všechna úmrtí od operace až do 30 dnů od propouštění byla prospektivně zaznamenána. Skutečná mortalita byla porovnána s mortalitou odvozenou z EuroSCORE.
Výsledky:
57 % pacientů podstoupilo kardiochirurgickou operaci, zatímco 43 % pacientů bylo kardiochirurgem odmítnuto. Mezi skutečnou a odvozenou mortalitou nebyl ani u jedné podskupiny zjištěn významný rozdíl. Aditivní i logistické EuroSCORE ukázalo dobrou diskriminační schopnost pro předpověď krátkodobého úmrtí (AUC = 0,755 a AUC = 0,762 pro chirurgickou skupinu; AUC = 0,695 a AUC = 0,716 pro odmítnutou skupinu).
Závěr:
EuroSCORE má dobrou diskriminační schopnost pro predikci časného úmrtí u pacientů po kardiochirurgické operaci a rovněž i u pacientů odmítnutých kardiochirurgem. Obě formy EuroSCORE pro predikci rizika jsou vhodné pro předpověď úmrtí u českých kardiologických pacientů.
Klíčová slova:
aditivní EuroSCORE – logistické EuroSCORE – předpověď úmrtí – pacienti indikovaní k operaci – pacienti odmítnutí k operaci
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Internal Medicine
2006 Issue 12
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