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修订的心脏风险指数预测了接受慢性脏替代疗法,接受选择性全科手术的患者的心血管并发症
Dharmenaan Palamuthusingam1,2,3, Elaine M Pascoe4, Carmel M Hawley5,6,7
1Metro North Kidney Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia. Dharmenaan.palamuthusingam@health.qld.gov.au.
Perioperative medicine (London, England)
|July 10, 2024
概括
修订后的心脏风险指数 (RCRI) 预测慢性脏替代疗法 (KRT) 患者的心血管事件不佳. 这个工具高估了风险,可能会误导在这个人群中选择性手术的临床决策.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 流行病学 流行病学
背景情况:
- 修订的心脏风险指数 (RCRI) 是评估外科手术期间心血管风险的标准工具.
- 它在接受慢性置换疗法 (KRT) 的患者中缺乏验证.
- 这项研究旨在对慢性KRT患者的RCRI进行外部验证.
研究的目的:
- 在慢性脏替代疗法 (KRT) 患者中,外部验证修订的心脏风险指数 (RCRI) 来预测30天的主要不良心血管事件 (MACE).
- 评估RCRI在接受选择性腹部手术的特定患者队列中的歧视和校准.
主要方法:
- 利用了澳大利亚和新西兰透析和移植 (ANZDATA) 注册表和住院数据 (2000-2015) 之间的数据链接.
- 包括发生病例和流行病例的慢性KRT (血液透析,腹腔透析,家庭血液透析,移植) 接受选择性腹部手术的患者.
- 通过逻辑回归,ROC曲线 (AUROC),校准图和决策曲线分析评估了30天的MACE (非致命的心肌梗塞,中风,心脏骤停,心血管死亡率).
主要成果:
- 在慢性KRT患者中,RCRI显示差异差 (AUROC 0.67),65岁以上患者的表现特别低 (AUROC 0.591).
- RCRI显著高估了MACE风险;RCRI分数分别为1,2和≥3,预期与观察的比为6.0,5.1和2.5.
- 在65岁以下的患者 (AUROC 0.740) 和脏移植接受者 (AUROC 0.718) 中观察到适度的歧视,后者群体的过高估计较少.
结论:
- 该RCRI工具表现不佳,并高估了选择性手术的慢性透析患者的心血管风险.
- 这些发现表明,RCRI可能会误导患者和临床医生,对这一群体的手术风险进行误导.
- 需要进一步的研究来开发一种更准确的风险评估工具,用于慢性KRT患者.
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