对破裂腹腔大动脉动脉瘤修复风险分层中的风险评分表现的比较评估风险分层
Andrew S Warren1, Jake F Hemingway2, Elina Quiroga2
1Division of Vascular Surgery, University of Washington, Seattle, WA, USA; Pacific Northwest University of Health Sciences, Yakima, WA, USA.
概括
通过比较破裂腹腔大动脉动脉瘤 (rAAA) 修复的七个风险评分,格拉斯哥动脉瘤评分 (GAS) 和荷兰动脉瘤评分 (DAS) 显示出优异的歧视,而医疗保险风险评分提供了最准确的死亡率预测.
科学领域:
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
- 生物统计学 生物统计学
背景情况:
- 破裂腹腔大动脉动脉瘤 (rAAA) 修复带有显著的死亡风险.
- 存在多个风险分数来分层这种风险,但它们的比较性能不清楚.
研究的目的:
- 为了比较rAAA修复的七个已确定的风险评分的区分和校准性能.
- 确定最有效的风险分层工具,用于rAAA的临床决策.
主要方法:
- 对2,134名NSQIP和6,458名接受rAAA修复 (开放或内血管) 的VQI患者进行了回顾性分析.
- 计算并比较了七个风险分数:DAS,GAS,mHRS,HI,Leiden,Medicare和VSGNE.
- 通过ROC曲线 (AUC) 和通过综合校准指数 (ICI) 的校准来评估歧视.
主要成果:
- GAS (NSQIP) 和DAS (VQI) 显示了最高的歧视 (AUC分别为0.687和0.688).
- 医疗保险风险评分显示了最佳的校准 (ICI 0.007 NSQIP,0.003 VQI).
- DAS低估了风险;其他得分高估了死亡率.
结论:
- 风险评分是对rAAA管理中的临床判断的宝贵补充,而不是替代品.
- GAS和DAS是区分风险水平的最佳方法;医疗保险得分提供了最准确的预测.
- mHRS和HI为紧急设置提供了性能和简单性的实用平衡.
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