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. 2020 Sep;115(3):452-459.
doi: 10.36660/abc.20190120.

Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

[Article in English, Portuguese]
Silvana Alves Dos Santos Franzotti  1 , Dyenily Alessi Sloboda  1 , Juliana Rosendo Silva  2 , Ellian Amorim Santos Souza  1 , Jessica Zamora Reboreda  1 , Renata Eloah de Lucena Ferretti-Rebustini  1 , Lilia de Souza Nogueira  1
Affiliations

Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

[Article in English, Portuguese]
Silvana Alves Dos Santos Franzotti et al. Arq Bras Cardiol. 2020 Sep.

Abstract
in English, Portuguese

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).

Fundamento: Os pacientes em pós-operatório (PO) de cirurgia de revascularização miocárdica (CRM) internados em unidade de terapia intensiva (UTI) apresentam risco de complicações que aumentam o tempo de permanência e a morbimortalidade. Portanto, é fundamental o reconhecimento precoce desses riscos para otimizar estratégias de prevenção e desfecho clínico satisfatório.

Objetivo: Analisar o desempenho de índices de gravidade na predição de complicações em pacientes no PO de CRM durante a permanência na UTI.

Métodos: Estudo transversal, com análise retrospectiva de prontuários eletrônicos de pacientes com idade ≥ 18 anos submetidos à CRM isolada e admitidos na UTI de um hospital cardiológico, em São Paulo, Brasil. As áreas sob as curvas receiver operating characteristic (AUC) com intervalo de confiança de 95% foram analisadas para verificar a acurácia dos índices European System for Cardiac Operative Risk Evaluation (EuroScore), Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II) e Sequential Organ Failure Assessment (SOFA) na predição de complicações.

Resultados: A casuística foi composta por 366 pacientes (64,58±9,42 anos; 75,96% sexo masculino). As complicações identificadas foram respiratórias (24,32%), cardiológicas (19,95%), neurológicas (10,38%), hematológicas (10,38%), infecciosas (6,56%) e renais (3,55%). O APACHE II apresentou satisfatório desempenho para a predição de complicações neurológicas (AUC 0,72) e renais (AUC 0,78).

Conclusão: O APACHE II se destacou na previsão das complicações neurológicas e renais. Nenhum dos índices teve bom desempenho na predição das outras complicações analisadas. Portanto, os índices de gravidade não devem ser utilizados indiscriminadamente com o objetivo de predizer todas as complicações frequentemente apresentadas por pacientes após CRM. (Arq Bras Cardiol. 2020; 115(3):452-459).

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Conflict of interest statement

Potencial Conflito de Interesses

Declaro não haver conflito de interesses pertinentes.

Figures

Figura 1
Figura 1. – Receiver Operating Characteristic Curves dos índices de gravidade na predição de complicações em pacientes após CRM. *EuroScore: European System for Cardiac Operative Risk Evaluation; †SOFA: Sepsis-related Organ Failure Assessment; ‡APACHE II: Acute Physiology and Chronic Health Evaluation; §SAPS II: Simplified Acute Physiology Score.
Figure 1
Figure 1. – Receiver Operating Characteristic Curves of severity indices in predicting complications in patients after CABG. *EuroScore: European System for Cardiac Operative Risk Evaluation; †SOFA: Sepsis-related Organ Failure Assessment; ‡APACHE II: Acute Physiology and Chronic Health Evaluation; §SAPS II: Simplified Acute Physiology Score.
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