Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

Abstract Background Patients in the postoperative period of myocardial revascularization (Coronary Artery Bypass Grafting - CABG) surgery admitted to the intensive care unit (ICU) are at risk of complications which increase the length of stay and morbidity and mortality. Therefore, early recognition of these risks is essential to optimize prevention strategies and a satisfactory clinical outcome. Objective To analyze the performance of severity indices in predicting complications in patients in the postoperative of CABG during the ICU stay. Methods A cross-sectional study with retrospective analysis of electronic medical records of patients aged ≥ 18 years who underwent isolated CABG and were admitted to the ICU of a cardiology hospital in São Paulo, Brazil. The areas under the receiver operating characteristic curves (AUC) with a 95% confidence interval were analyzed to verify the accuracy of the European System for Cardiac Operative Risk Evaluation (EuroScore), Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) indices in predicting complications. Results The sample consisted of 366 patients (64.58 ± 9.42 years; 75.96% male). The complications identified were: respiratory (24.32%), cardiovascular (19.95%), neurological (10.38%), hematological (10.38%), infectious (6.56%) and renal (3.55%). APACHE II showed satisfactory performance for predicting neurological (AUC 0.72) and renal (AUC 0.78) complications. Conclusion APACHE II excelled in predicting neurological and renal complications. None of the indices performed well in predicting the other analyzed complications. Therefore, severity indices should not be used indiscriminately in order to predict all complications frequently presented by patients after CABG. (Arq Bras Cardiol. 2020; 115(3):452-459)

摘要

研究背景：接受心肌血运重建术（即冠状动脉旁路移植术，Coronary Artery Bypass Grafting，CABG）后入住重症监护病房（intensive care unit，ICU）的患者，存在发生并发症的风险，此类并发症会延长住院时长，增加并发症发生率与死亡率。因此，早期识别此类风险对于优化预防策略、获得满意的临床结局至关重要。

研究目的：分析重症监护病房住院期间，冠状动脉旁路移植术后患者并发症预测中各类严重程度评分模型的预测效能。

研究方法：本研究为横断面回顾性研究，对巴西圣保罗某心脏病医院重症监护病房内、年龄≥18岁且接受单纯冠状动脉旁路移植术的患者的电子病历进行回顾性分析。采用受试者工作特征曲线（receiver operating characteristic curves，ROC）下面积（area under the curve，AUC）结合95%置信区间，评估欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluation，EuroSCORE）、急性生理学与慢性健康状况评分Ⅱ（Acute Physiology and Chronic Health Evaluation，APACHE Ⅱ）、简化急性生理学评分Ⅱ（Simplified Acute Physiology Score，SAPS Ⅱ）及序贯器官衰竭评估（Sequential Organ Failure Assessment，SOFA）评分对并发症的预测准确性。

研究结果：本研究共纳入366例患者，年龄为64.58±9.42岁，男性占比75.96%。共识别出以下并发症：呼吸系统并发症（24.32%）、心血管并发症（19.95%）、神经系统并发症（10.38%）、血液系统并发症（10.38%）、感染性并发症（6.56%）及肾脏并发症（3.55%）。APACHE Ⅱ评分对神经系统并发症（AUC=0.72）与肾脏并发症（AUC=0.78）具有较好的预测效能。

研究结论：APACHE Ⅱ评分在神经系统与肾脏并发症的预测中表现最优。其余纳入分析的评分模型均无法较好预测其他类型并发症。因此，不可盲目使用各类严重程度评分模型来预测冠状动脉旁路移植术后患者常见的各类并发症。

（《巴西心脏病学档案》（Arq Bras Cardiol. 2020; 115(3):452-459））