对于破裂腹腔大动脉动脉瘤的传统和修改的Harbourview风险评分的外部验证30天死亡率预测
Edoardo Frola1, Lorenzo Mortola1, Fabio Barili2
1Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Cuneo, Italy.
Annals of vascular surgery
|September 28, 2024
概括
传统和修改的Harbourview风险评分 (tHRS和mHRS) 在预测腹腔大动脉瘤破裂 (rAAA) 患者的30天死亡率方面显示出有限的准确性. 提高这些分数需要考虑风险因素之间的相互作用,特别是对高风险个体.
科学领域:
- 血管外科 血管外科
- 手术风险评估手术风险评估
- 大动脉动脉瘤研究研究
背景情况:
- 术前风险分层对于腹腔大动脉动脉瘤破裂 (rAAA) 患者至关重要.
- 传统和修改的Harbourview风险评分 (tHRS和mHRS) 用于估计30天死亡率.
- 这些分数在多样化的rAAA人群中需要外部验证.
研究的目的:
- 在rAAA患者的外部队列中验证tHRS和mHRS的预测准确性.
- 评估tHRS和mHRS的区分和校准.
- 通过更新风险模型来探索潜在的改进.
主要方法:
- 连续105名接受修复的rAAA患者的回顾性审查.
- 计算每个患者的tHRS和mHRS.
- 使用接收器运行特征曲线 (ROC),曲线下的面积 (AUC) 和校准图表进行评估.
- 多变量逻辑回归和引导分析来更新模型.
主要成果:
- 30天死亡率为31.4%,为30天死亡率.
- 对于tHRS的AUC为0.56和mHRS为0.68,表明预测能力有限.
- 这两种评分都显示了校准问题,在某些患者群体中高估了死亡率.
- 模型更新表明,因子相互作用影响预测准确性.
结论:
- 在rAAA患者中,tHRS和mHRS对30天死亡率的预测性能有限.
- 通过这些得分过度估计死亡风险,引起了人们对广泛临床使用的担忧.
- 纳入风险因素之间的相互作用对于改善风险预测模型至关重要,特别是对于高风险患者.
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