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 背景】接受心肌血运重建术（冠状动脉旁路移植术，Coronary Artery Bypass Grafting, CABG）的患者，在入住重症监护病房（intensive care unit, ICU）的术后阶段存在并发症风险，此类并发症会延长住院时长、增加发病率与死亡率。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】分析多种严重程度评分工具在预测CABG术后ICU住院患者并发症方面的效能。 【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学医院ICU收治的、接受单纯CABG术且年龄≥18岁患者的电子病历进行分析。通过分析受试者工作特征曲线下面积（AUC）及其95%置信区间，验证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系统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）以及序贯器官衰竭评估（Sequential Organ Failure Assessment, SOFA）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%。本次识别的并发症包括：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%）以及肾脏并发症（3.55%）。APACHE Ⅱ在预测神经系统并发症（AUC=0.72）与肾脏并发症（AUC=0.78）方面表现良好。 【研究结论】APACHE Ⅱ在神经系统与肾脏并发症的预测中表现最优。其余评分工具对本次研究分析的其他并发症均无良好预测效能。因此，不应不加区分地使用严重程度评分工具来预测CABG术后患者常出现的各类并发症。（《巴西心脏病学档案》2020; 115(3):452-459）