A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

作者：Andersson Charlotte^*; Gislason Gunnar H; Hlatky Mark A; Sondergaard Kathrine Bach; Pallisgaard Jannik; Smith J Gustav; Vasan Ramachandran S; Larson Martin G; Jensen Per Foge; Kober Lars; Torp Pedersen Christian

来源：European Journal of Heart Failure, 2014, 16(12): 1310-1316.

DOI：10.1002/ejhf.182

• Heart failure
• Mortality
• Non-cardiac surgery
• Risk factors
• Risk prediction

BackgroundHeart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. %26lt;br%26gt;Methods and resultsAll individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n=16827). In total, 1787 (10.6%) died within 30days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56-65years (2), age 66-75years (4), age 76-85years (5), or age %26gt;85years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from %26lt;2% for a score %26lt;5 to %26gt;50% for a score 20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P%26lt;0.05 performed only slightly better, c-statistic=0.81, but was limited in use by its complexity. %26lt;br%26gt;ConclusionsFor patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality.

• 出版日期2014-12