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

@#Objective TocomparethepredictiveefficacyofEuroSCOREⅡandSinoSCOREinthepostoperative mortalityofChinesepatientsunderwentcoronaryarterybypassgrafting(CABG). Methods Theclinicaldataof4507 patientswithCABGatourdepartmentinJanuary2011andApril2015wereretrospectivelyanalyzed.Cardiovascularrisk stratificationwasperformedonpatientsusingEuroSCOREⅡandSinoSCORE.PatientsweredividedintoⅠ,Ⅱ,ⅢandⅣ groupsaccordingtothepredictedfatalityrates.Themortalityrateswerepredictedinallgroupsofpatientsrespectively. Predictive effectiveness was analyzed by the analysis of discernment and calibration force. Results The in-hospital mortalityratewas1.35%inallpatients,whilethemeanmortalityratepredictedbyEuroSCOREⅡwas1.470%±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 EuroSCOREⅡandSinoSCOREwere0.728and0.716.ItwasfoundthatthecalibrationdegreeofEuroSCOREⅡwaspoor andSinoSCOREwasacceptabledetectedbyHosmer-LemeshowTest.EuroSCOREⅡunderestimatedthemortalityratesof groupⅣ,butoverestimatedmortalityratesinothergroupsofpatients.SinoSCOREunderestimatedmortalityratesofpatients ingroupⅠandoverestimatedmortalityratesinothergroupsofpatients.EuroSCOREⅡonlyachievedgooddiscrimination forpatientsofgroupⅠ(AUC=0.707),andSinoSCOREachievedgooddiscriminationforpatientsofgroupⅡ(AUC=0.754). EuroSCOREⅡoverestimatedthemortalityrateintheisolatedCABGgroupandunderestimatedmortalityratesinpatients withothercardiacsurgeries.SinoSCOREoverestimatedmortalityratesingroupⅡ.TheAUCvaluesofEuroSCOREⅡand SinoSCOREwere0.694and0.687inisolatedCABGgroup.TheAUCvaluesofEuroSCOREⅡandSinoSCOREwere0.772 and0.669inCABGcombinedwithothercardiacsurgeries.Conclusion EuroSCOREⅡhasagoodpredictiveefficacyin theentiregroupofpatientsandⅠ,ⅡandⅢgroups,buthasapoorperformanceingroupⅣ.SinoSCOREoverestimates mortalityratesintheentiregroupandⅠ,ⅡandⅢgroups,anditunderestimatesmortalityratesinpatientsofgroupⅠ. Theapplicationandestablishmentofriskmodelsshouldfocusondifferentheartdiseasesanddifferentrisklevels,andthe modelingmethodofestablishedrisksystemsneedstobeimproved.

Validation of the Chinese System for Cardiac Operative Risk Evaluation(SinoSCORE) in Chinese heart valve surgery: the experience from department of cardiothoracic surgery of Changhai Hospital / 中华胸心血管外科杂志

Objective To assess the Chinese System for Cardiac Operative Risk Evaluation (SinoSCORE) model in patients undergoing heart valve surgery at our center.Methods From January 2009 to December 2011,2098 consecutive adult patients who underwent heart valve surgery at our center were collected and scored according to the SinoSCORE model.All patients were divided into three risk subgroups.The entire cohort and each risk subgroup were analysed.Calibration of the SinoSCORE 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 of all 2098 patients was 3.00％.Despite there were significant differences between the SinoSCORE population and our own population sample,the SinoSCORE model showed good calibration(Hosmer-Lemeshow:P =0.783) and discriminative power (area under the ROC curve of 0.752)in predicting in-hospital mortality at the entire cohort.Conclusion The SinoSCORE model give an accurate prediction for individual operative risk in heart valve surgery patients at our center.

Performance of SinoSCORE in predicting in-hospital mortality and postoperative complications after cardiac valve surgery / 第二军医大学学报

Objective: To evaluate the performance of the Chinese system for cardiac operative risk evaluation (Sino SCORE) in predicting the in-hospital mortality and postoperative complications in patients undergoing cardiac valve surgery. Methods: The clinical data of patients undergoing valve surgery in Changhai Hospital between 2005 and 2011 were retrospectively analyzed. Sino SCORE was used to calculate the in-hospital mortality risk. The relationship of Sino SCORE result with postoperative complications (low cardiac output syndrome, renal failure, lung infection, application of intra-aortic balloon pump [IABP], prolonged ventilation, prolonged postoperative ICU stay and reoperation) was verified. Discrimination degree of the model was tested by determining the area under the receiver operating characteristic (ROC) curve, and calibration of the model was evaluated by Hosmer-Lemeshow goodness-of-fit test. The optimal cut-off points for postoperative complications, which could be well predicted by Sino SCORE, were obtained by Youden index. Results: The mean age of the 3 407 enrolled patients was (49. 2 ± 13. 3) years. The area under ROC was 0. 754 (95%CI: 0. 701-0. 806), indicating good discrimination power of the model in predicting in-hospital mortality. The overall in-hospital mortality was 3. 05% (104/3 407). The predicted in-hospital mortality by Sino SCORE was (3. 1 ± 0. 1)%. Hosmer-Lemeshow calibration test yielded χ2 = 9. 454, P = 0. 490, suggesting a high calibration ability of the model. The areas under ROC of low cardiac output syndrome, renal failure, and application of IABP were 0. 708, 0. 711, and 0. 718, respectively, suggesting that Sino SCORE had a satisfactory performance in predicting post-operative low cardiac output syndrome, renal failure, and application of IABP. And the optimal cut-off points for the above three complications predicted by Sino SCORE were 5. 5, 7. 5, and 6. 0, respectively. Conclusion: Sino SCORE has a better performance in predicting the in-hospital mortality risk in Chinese patients undergoing valve surgery, and it can better predict post-operative low cardiac output syndrome, renal failure, and application of IABP.

Predictive value of SinoSCORE on in-hospital mortality and postoperative complications after coronary artery bypass surgery / 中华胸心血管外科杂志

Objective To evaluate the performance of the Sino System for Coronary Operative Risk Evaluation ( SinoSCORE) on in-hospital mortality and postoperative complications in patients undergoing coronary artery bypass grafting (CABG) in a single heart center. Methods From January 2007 to December 2008, clinical information of 201 consecutive patients undergoing isolated CABG in our hospital was collected. The SinoSCORE was used to predict hospital mortality and major complications[sternal wound infection, postoperative renal failure, multiple organ dysfunction syndrome, perioperative intra-aortic balloon pumps ( IABP), etc.]after CABG among our study participants, which was initially designed as CBAG operative risk scoring system and included 11 risk factors. We estimated the predictable capability of SinoORE model by the means of analysing the calibration and discrimination characters of this risk scoring system. Calibration was evaluated with the method of Hosmer-Lemeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. The optimal cut-off point for SinoSCORE predicting major complications was obtained by the Youden index. Results Of all our study patients, the observed in-hospital mortality was 1.99% (4/201). The overall mean baseline age was ( 63.3 ± 9.2 ) years and 24.4% ( 49/201 ) were female. The predicted mortality cakulated by the SinoSCORE was 2.88% which was slightly higher than the actual mortality. SinoSCORE model slwed very high discriminatory ability and the good calibration power in predicting in-hospital mortality: Hosmer-Lemeshow calibration test:x2 =4. 304, P =0.744 and area under ROC was 0. 81 (95% CI: 0.687 -0.932). As for the major postoperative complications after CABG,SinoSCORE model still achieved a satisfactory performance with the good predictive value for the main complications risk evaluation such as postoperative renal failure, multiple organ dysfunction syndrome and IABP. Hosmer-Lemeshow: P =0.75, P =0. 75, P = 1.00; Areas under ROC respectively at was 0. 768 ( 95 % CI: 0.613 - 0. 924 ). 0. 832 ( 95 % CI: 0. 732 - 0. 932 )and 0. 737 (95% CI: 0. 607 -0. 867 ). The optimal cut-off points for SinoSCORE model predicting each of the above three major postoperative complications was ultimately determined to be 4.5. Conclusion In our patient database, the SinoSCORE model proved a good preoperative risk model in predicting both in-hospital mortality and major complications after CABG, which provides a realistic estimation of hospital death and post-operative complications risk for patients undergoing CABG. Sinoscore model is a suitable operative risk estimation system for Chinese CABG patients.

Validation of the Chinese system for cardiac operative risk evaluation (SinoSCORE): the experience from Guangdong Cardiovascular Institute / 中华胸心血管外科杂志

Objective To validate of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in Cantonese surgery patients. Methods Data from Guangdong Cardiovascular Institute in the period January 2004 through December 2008 were analyzed on 2462 Cantonese heart surgery patients. First, compared risk factors of this series and database of SinoSCORE, and then calculated the additive score of each patients and evaluate the discrimination and calibration of sinoSCORE in Cantonese patients. Results There were some differences between the risk factors of patients from two groups. The gender,smoking, diabetes, hyperlipemia, hypertension, chronic pulmonary diseases, stroke, cardiovascular surgery history, left main disease, atrial fibrillation/atrial flutter, pulmonary arterial hypertension, concomitant coronary surgery and concomitant valve surgery in Cantonese patients were different between two groups. However, The SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination ( Hosmer-Lemeshow test, P = 0. 34 ) and calibration ( the area under the receiver operating characteristic curve, 0.84, P ＜ 0.01 ). Conclusion SinoSCORE was able to predict the in-hospital mortality of Cantonese heart surgery patients.

SinoSCORE can predict the early mortality of patients with valve surgery / 中华胸心血管外科杂志

Objective To validate the predictive value of SinoSCORE in patients undergoing valve surgery. Methods The clinical data of 13 ±353 patients undergone valve surgery from 43 Chinese cardiac centers between January 2007 and December 2008 were retrospectively analyzed. The score values of all patients were calculated according to the SinoSCORE model.The calibration was tested by the Hosmer-Lemeshow goodness-of-fit statistic. Area under the receiver operator curves ( ROC )was calculated to evaluate the model' s discriminatory ability. Results The mean age of the total patients was (48.0 ± 11.7 )years. Most of the patients were women (58% versus 42% ). The data contained 2505 cases of aortic valve surgery, 6996 cases of mitral valve surgery and 4002 cases of double valve surgery ( concomitant aortic and mitral valve surgery). The area under the ROC (0.74,95% confidence interval 0.70 -0.78 ) revealed that the SinoSCORE possessed strong discriminatory power between high- and low risk patients. The Hosmer-Lemeshow goodness-of-fit test (P = 0.47 ) validated the good predictive ability of SinoSCORE. Conclusion SinoSCORE can accurately predict the early mortality in patients with valve surgery. It is a good and well-validated risk stratification model applicable to patients with valve surgery.

Set up and validation of Chinese Risk Stratification System for Coronary Artery Bypass Grafting / 中华胸心血管外科杂志

Objective Our study aims to evaluate the performance of Chinese risk stratification system for coronary artery bypass grafting (CABG) in the prediction of in-hospital mortality and major postoperative complications after CABG. Methods Clinical information of 9564 consecutive CABG patients was collected in Chinese Coronary Artery Bypass Grafting Registry which recruited 43 centers over China between 2007 and 2008. Sino System for Coronary Operative Risk Evaluation ( SinoSCORE) was developed using the logistic regression model. The SinoSCORE model was designed to predict in-hospital mortality among patients undergoing coronary artery bypass surgery. The scoring system finally identified 11 risk factors including age over 65, preoperative NYHA stage, chronic renal failure, chronic obstructive pulmonary disease, etc. Cut-off point was defined for SinoSCORE model to distinguish low( SinoSCORE: ≤ 1 ), moderate( SinoSCORE :2 -5 ) and high risk groups(≥6).AUC statistic (receiver operating characteristic curve) was used to test discrimination of SinoSCORE model and we assessed calibration of this model by the Hosmer-Lemeshow goodness-of-fit statistic. The above-mentioned results were compared with the European Risk System in Cardiac Operations (EuroSCORE). And we also assessed the applicability of SinoSCORE model in the prediction of in-hospital mortality among the three different risk groups by comparing the 95% confidence interval (CI) between the morbidity observed with that expected. Results SinoSCORE model showed good performance ( HL P ＞ 0. 05, AUC ＞ 0. 70 ) in the prediction of in-hospital mortality and postoperative complications. Of our study population, calibration by Hosmer-Lemeshow (HL) test for in-hospital mortality was P=0.70, discrimination by area under ROC (AUC) was 0.80. And for major postoperative complications, the risk model SinoSCORE model still turned out good including the following: stroke ( HL P = 0. 43, AUC = 0. 76, renal failure ( HL P = 0. 70, AUC = 0. 72 ), prolonged ventilation ( HL P = 0. 18, AUC = 0.70 ),multiple organ failure( HL P =0.49 ,AUC =0.79). By comparison with EuroSCORE model, SinoSCORE model proved better prediction ability in both the discrimination and calibration based on our research crowd. And during the different danger degree of patients, mortality observations 95% CI and estimated values of 95% CI were very good overlap, which indicated that this model for the three different risk groups are applicable. Conclusion SinoSCORE model is based on the newest clinical date of Chinese patients undergoing CABG. SinoSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also postoperative complications. SinoSCORE proved better performance than the EuroSCORE model in Chinese CABG patients and is more suitable for? application? among? domestic cardiac surgery? physicians.

The prediction of early mortality in off-pump coronary artery bypass surgery: SinoSCORE versus EuroSCORE / 中华胸心血管外科杂志

Objective To compare the validation of the Sino System for Coronary Operative Risk Evaluation ( SinoSCORE ) with the Europe an system for cardiac operative risk evaluation ( EuroSCORE ) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery in China. Methods Data of patients who underwent OPCAB between 2004 and 2005 in the Chinese coronary artery bypass grafting registry study were collected. The end point of the study was postoperative in-hospital death. Predicted mortality were calculated using the SinoSCORE and the logistic EuroSCORE, and compared with observed mortality. Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic(ROC) curve. Results 73 of 4920 patients died in hospital and the observed mortality was 1.48%. The predicted mortality calculated by the SinoSCORE and the EuroSCORE was 2.73% and 4. 13% respectively. For SinoSCORE the Hosmer-Lemeshow test was non-significant ( P = 0. 636 ) and the area under ROC curve was 0. 794. For the EuroSCORE the HL test was significant( P = 0.01 ) and the area under ROC curve was 0. 756. Both the SinoSCORE and the logistic EuroSCORE provides good discrimination, but the SinoSCORE showed better calibration than EuroSCORE, that is, both the two models were significantly correlated to postoperative death, but SinoSCORE is more accurate than EuroSCORE at predicting postoperative in-hospital mortality. Conclusion SinoSCORE seems to be more suitable than EuroSCORE in predicting postoperative in-hospital mortality for OPCAB patients in China.

Validation of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in senior heart surgery patients / 中华胸心血管外科杂志

Objective To validate of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in senior heart surgery patients. Methods Data from 43 Chinese Medical Centers in the period January 2004 through December 2008 were analyzed on 9445 heart surgery patients aged over 65 years. Firstly, risk factors of this series and database of SinoSCORE were compared. Then, the additive score of each patients and the discrimination and calibration of sinoSCORE in elder patients were calculated. Results There were significant differences between the risk factors of patients from two groups. Howerever,the SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination ( Hosmer-Lemeshow test,P =0.45 ) and calibration (the area under the receiver operating characteristic curve, 0.73, P ＜ 0.01 ). Conclusion SinoSCORE was able to predict the in-hospital mortality of senior heart surgery patients.