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Ein neuer Score für die tägliche Schweregradklassifizierung auf herzchirurgischen Intensivstationen

A new score for daily risk stratification in ICU cardiac surgical patients

  • ORIGINALARBEIT
  • Published:
Zeitschrift für Herz-, Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Einleitung:

Das Ziel dieser Studie war die Entwicklung eines spezifischen Schweregradklassifizierungssystems für die Beurteilung und Vorhersage von Organfunktionsstörungen und Überleben bei herzchirurgischen Intensivpatienten.

Methoden:

Hierzu wurden konsekutiv alle erwachsenen Patienten nach einem herzchirurgischen Eingriff unter Einsatz der Herzlungenmaschine über einen Zeitraum von 3 Jahren in die Studie aufgenommen. Im Konstruktionsset erfolgte die Auswahl der Variablen mit Hilfe der Patienten, die mindestens 24 Stunden auf der Intensivstation verbrachten. Die Ergebnisse wurden dann in zwei Validierungssets mit allen Intensivpatienten überprüft. Die Qualität des Scores wurde mit dem Hosmer-Lemeshow-Test (HL) sowie der ROC-Analyse beurteilt, und mit dem APACHE-II- und dem MODS-Score verglichen.

Ergebnisse:

Insgesamt wurden 3230 Patienten über einen Zeitraum von 3 Jahren auf unserer Intensivstation aufgenommen. Die HL-Werte für den neuen Score waren 5,8 (APACHE-II: 11,3; MODS: 9,7) für das Konstruktionsset, 7,2 (APACHE-II: 8,0; MODS: 4,5) für das Validierungsset I und 5,9 für das Validierungsset II. Die Fläche unter der ROC-Kurve war 0,91 (APACHE-II: 0,86; MODS: 0,84) für den neuen Score im Konstruktionsset, 0,88 (APACHE-II: 0,84; MODS: 0,84) in dem Validierungsset I, und 0,92 in dem Validierungsset II.

Schlussfolgerung:

Der neue CASUS (Cardiac Surgery Score) zeigt für herzchirurgische Intensivpatienten eine exzellente Kalibrierung und Diskriminierung bezüglich der 30-Tage-Letalität. Die Variablen des CASUS sind einfach, reproduzierbar und werden routinemäßig in herzchirurgischen Intensivstationen erfasst. Der CASUS könnte als Expertensystem für das Diagnostizieren von Organfunktionsstörungen, der Entscheidungsfindung, der Ressourcenauswertung und Vorhersage der Letalität für herzchirurgische Intensivpatienten dienen.

Summary

Background:

The purpose of this study was to develop a specific postoperative score in intensive care unit (ICU) cardiac surgical patients for assessment of organ dysfunction and survival.

Methods:

This prospective study consisted of all consecutive adult patients admitted after cardiac surgery to our ICU over a period of 3 years. Evaluation of variables was performed using the first year patients who stayed in ICU for at least 24 hours. The reproducibility was then tested in two validation sets using all patients. Performance was assessed with the Hosmer-Leme-show (χ 2-statistics) goodness-of-fit test and receiver operating characteristic (ROC) curves and compared with the APACHE II and MODS.

Results:

A total of 3230 patients were admitted to the ICU after cardiac surgery. Mean χ 2-values for the new score were 5.8 (APACHE II, 11.3; MODS, 9.7) for the construction set, 7.2 (APACHE II, 8.0; MODS, 4.5) for the validation set I and 5.9 for the validation set II. The mean area under the ROC curve was 0.91 (APACHE II, 0.86; MODS, 0.84) for the new score in the construction set, 0.88 (APACHE II, 0.84; MODS, 0.84) in the validation set I and 0.92 in the validation set II.

Conclusion:

Our new ten-variable risk index performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool for daily risk stratification in ICU cardiac surgery patients. Thus, it may serve as an Expert System for diagnosing organ failure, decision making, resource evaluation, and predicting mortality in ICU cardiac surgical patients.

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Authors and Affiliations

  1. Klinik und Poliklinik für Herz- und Thoraxchirurgie der Universität zu Köln, Kerpener Str. 62, 50924, Köln, Germany

    K. Hekmat,  A. Kröner,  G. B. W. E. Bennink &  U. Mehlhorn

  2. Institut für medizinische Statistik, Informatik und Epidemiologie der Universität zu, Köln

    H. Stützer

  3. Klinik und Poliklinik für Kardiologie der Universität zu, Köln

    R. H. G. Schwinger

  4. Klinik für Anästhesiologie der Universität zu, Köln

    S. Kampe

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  1. K. Hekmat
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  2. A. Kröner
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  4. R. H. G. Schwinger
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  7. U. Mehlhorn
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Correspondence to K. Hekmat.

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Hekmat, K., Kröner, A., Stützer, H. et al. Ein neuer Score für die tägliche Schweregradklassifizierung auf herzchirurgischen Intensivstationen. Z Herz-, Thorax-, Gefäßchir 18, 257–267 (2004). https://doi.org/10.1007/s00398-004-0473-x

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  • DOI: https://doi.org/10.1007/s00398-004-0473-x

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