Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.

<h4>Background</h4>Operative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the op...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Marco Ranucci, Andrea Ballotta, Serenella Castelvecchio, Ekaterina Baryshnikova, Simonetta Brozzi, Alessandra Boncilli, Surgical and Clinical Outcome Research (SCORE) Group
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/55a9ec07709f437f9dd0c75ebf3d8415
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:55a9ec07709f437f9dd0c75ebf3d8415
record_format	dspace
spelling	oai:doaj.org-article:55a9ec07709f437f9dd0c75ebf3d84152021-11-18T07:03:00ZIntensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.1932-620310.1371/journal.pone.0013551https://doaj.org/article/55a9ec07709f437f9dd0c75ebf3d84152010-10-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21042411/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Operative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the operative mortality. This study investigates the association between a number of parameters at the admission in the intensive care unit and the operative mortality, and verifies the hypothesis that including these parameters into the preoperative risk models may increase the accuracy of prediction of the operative mortality.<h4>Methodology</h4>929 adult patients who underwent cardiac surgery were admitted to the study. The preoperative risk profile was assessed using the logistic EuroSCORE and the ACEF score. A number of parameters recorded at the admission in the intensive care unit were explored for univariate and multivariable association with the operative mortality.<h4>Principal findings</h4>A heart rate higher than 120 beats per minute and a blood lactate value higher than 4 mmol/L at the admission in the intensive care unit were independent predictors of operative mortality, with odds ratio of 6.7 and 13.4 respectively. Including these parameters into the logistic EuroSCORE and the ACEF score increased their accuracy (area under the curve 0.85 to 0.88 for the logistic EuroSCORE and 0.81 to 0.86 for the ACEF score).<h4>Conclusions</h4>A double-stage assessment of operative mortality risk provides a higher accuracy of the prediction. Elevated blood lactates and tachycardia reflect a condition of inadequate cardiac output. Their inclusion in the assessment of the severity of the clinical conditions after cardiac surgery may offer a useful tool to introduce more sophisticated hemodynamic monitoring techniques. Comparison between the predicted operative mortality risk before and after the operation may offer an assessment of the operative performance.Marco RanucciAndrea BallottaSerenella CastelvecchioEkaterina BaryshnikovaSimonetta BrozziAlessandra BoncilliSurgical and Clinical Outcome Research (SCORE) GroupPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 10, p e13551 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marco Ranucci Andrea Ballotta Serenella Castelvecchio Ekaterina Baryshnikova Simonetta Brozzi Alessandra Boncilli Surgical and Clinical Outcome Research (SCORE) Group Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
description	<h4>Background</h4>Operative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the operative mortality. This study investigates the association between a number of parameters at the admission in the intensive care unit and the operative mortality, and verifies the hypothesis that including these parameters into the preoperative risk models may increase the accuracy of prediction of the operative mortality.<h4>Methodology</h4>929 adult patients who underwent cardiac surgery were admitted to the study. The preoperative risk profile was assessed using the logistic EuroSCORE and the ACEF score. A number of parameters recorded at the admission in the intensive care unit were explored for univariate and multivariable association with the operative mortality.<h4>Principal findings</h4>A heart rate higher than 120 beats per minute and a blood lactate value higher than 4 mmol/L at the admission in the intensive care unit were independent predictors of operative mortality, with odds ratio of 6.7 and 13.4 respectively. Including these parameters into the logistic EuroSCORE and the ACEF score increased their accuracy (area under the curve 0.85 to 0.88 for the logistic EuroSCORE and 0.81 to 0.86 for the ACEF score).<h4>Conclusions</h4>A double-stage assessment of operative mortality risk provides a higher accuracy of the prediction. Elevated blood lactates and tachycardia reflect a condition of inadequate cardiac output. Their inclusion in the assessment of the severity of the clinical conditions after cardiac surgery may offer a useful tool to introduce more sophisticated hemodynamic monitoring techniques. Comparison between the predicted operative mortality risk before and after the operation may offer an assessment of the operative performance.
format	article
author	Marco Ranucci Andrea Ballotta Serenella Castelvecchio Ekaterina Baryshnikova Simonetta Brozzi Alessandra Boncilli Surgical and Clinical Outcome Research (SCORE) Group
author_facet	Marco Ranucci Andrea Ballotta Serenella Castelvecchio Ekaterina Baryshnikova Simonetta Brozzi Alessandra Boncilli Surgical and Clinical Outcome Research (SCORE) Group
author_sort	Marco Ranucci
title	Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
title_short	Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
title_full	Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
title_fullStr	Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
title_full_unstemmed	Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
title_sort	intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/55a9ec07709f437f9dd0c75ebf3d8415
work_keys_str_mv	AT marcoranucci intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery AT andreaballotta intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery AT serenellacastelvecchio intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery AT ekaterinabaryshnikova intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery AT simonettabrozzi intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery AT alessandraboncilli intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery AT surgicalandclinicaloutcomeresearchscoregroup intensivecareunitadmissionparametersimprovetheaccuracyofoperativemortalitypredictivemodelsincardiacsurgery
_version_	1718423976928083968

Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery.

Ejemplares similares