Biagioli et al developed models for predicting morbidity following coronary artery bypass graft (CABG) surgery. This can help identify patients who are at higher risk of complications and to compare outcomes. The authors are from University of Siena in Siena, Italy.
Endpoint: Post-operative morbidity - one or more of the following (page 4 of 13):
(1) cardiovascular complications (myocardial infarction, low cardiac output, severe arrhythmia, cardiopulmonary resuscitation)
(2) respiratory complications (prolonged ventilatory support, ARDS, reintubation, tracheostomy
(3) neurological complications (diffuse encephalopathy, focal brain lesion, delayed failure to awaken)
(4) renal complications (acute renal failure, need for dialysis)
(5) infectious complications (pneumonia, mediastinitis, wound infection, sepsis, septic shock)
(6) hemorrhagic complications (bleeding necessitating re-operation)
Parameters in the fully customized score model:
(1) pulmonary artery hypertension (PAH)
(2) presence of peripheral vascular disease and/or carotid artery disease
(3) treated diabetes
(4) left ventricular ejection fraction (LVEF) <= 35%
(5) intra-aortic balloon pump (IABP) required after CABG
(6) inotropic support after cardiopulmonary bypass
(7) age in years
(8) preoperative serum creatinine in mg/dL
(9) duration of cardiopulmonary bypass
(10) temperature in °C
(11) mixed venous oxygen saturation in percent
(12) carbonic dioxide production in mL per minute
(13) oxygen delivery index in mL per minute per square meter BSA (see 08.06.04)
where:
• Items 2, 5, 6, 7, 8, 9 and 13 are shared with the partially customized model.
|
Parameter |
Finding |
Coefficient |
Points |
|
pulmonary artery hypertension |
absent |
0 |
0 |
|
|
present |
1.40 |
3 |
|
vascular disease |
absent |
0 |
0 |
|
|
present |
0.91 |
2 |
|
treated diabetes |
no |
0 |
0 |
|
|
yes |
0.57 |
1 |
|
LVEF in percent |
> 35% |
0 |
0 |
|
|
<= 35% |
0.32 |
1 |
|
IABP after CABG |
no |
0 |
0 |
|
|
yes |
2.93 |
6 |
|
inotropic support after |
no |
0 |
0 |
|
|
yes |
0.96 |
2 |
|
age in years |
< 70 years |
0 |
0 |
|
|
>= 70 years |
0.34 |
1 |
|
preop serum creatinine |
< 1.2 mg/dL |
0 |
0 |
|
|
>= 1.2 mg/dL |
0.24 |
1 |
|
duration cardiopulmonary bypass |
< 2 hours |
0 |
0 |
|
|
>= 2 hours |
0.27 |
1 |
|
temperature in °C |
> 35°C |
0 |
0 |
|
|
<= 35°C |
0.49 |
1 |
|
mixed venous oxygen saturation |
> 62.5% |
0 |
0 |
|
|
<= 62.5% |
0.53 |
1 |
|
carbonic dioxide production |
> 175 mL per minute |
0 |
0 |
|
|
<= 175 mL per minute |
0.37 |
1 |
|
oxygen delivery index |
> 300 mL/min/sq m |
0 |
0 |
|
|
<= 300 mL/min/sq m |
0.71 |
1 |
total sum of coefficients = X =
= SUM(coefficients for all 13 parameters) - 5.11
probability of morbidity after CABG =
= 1 / (1 + EXP((-1) * (X))
total point sum =
= SUM(points for all 13 parameters)
Interpretation:
• minimum total point score: 0
• maximum total point score: 22
• A total point score >= 4 was associated with significant morbidity (high risk; see footnote Table 5).
Specialty: Cardiology, Surgery, general
ICD-10: ,
