Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar
Autor(a) principal: | |
---|---|
Data de Publicação: | 2021 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/9889 |
Resumo: | Background: Due to population aging, prevalence of aortic stenosis and limited number of scores in the literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. Objective: To construct a clinical death risk score from the data of patients with aortic stenosis submitted to valve replacement surgery. Methods: Observational study of historical cohort. Data collected from 802 patients with aortic stenosis who underwent valve replacement at the São Lucas Hospital of PUCRS between January 1996 and July 2018 were analyzed. Through the aid of multiple logistic regression in a forward stepwise process, a weighted risk score was built based on the magnitude of the coefficients ß of the logistic equation. When they were transformed (exp [ß]) into odds ratios (odds ratios), the values have been rounded up to the whole number using the truncation process to compose the final score. Two performance statistics were obtained: statistic c (area under the ROC curve) and the Hosmer-Lemeshow chi-square of goodness-of-fit with the Pearson correlation coefficient between the observed events and those predicted by the model. Results: The risk predictors that made up the score were: valve replacement surgery combined with coronary artery bypass graft, prior renal failure, presence of NYHA III/IV class heart failure, age greater than 70 years and ejection fraction less than 50%. The area under the ROC curve was 0.77 (CI: 95%, 0.72-0.82). The risk model showed good ability for observed / predicted mortality: Hosmer-Lemeshow test was c2 = 3.70 (p = 0.594) and Pearson's coefficient was r = 0.98 (p < 0.001). Conclusion: We propose a risk score for hospital death in patients undergoing aortic valve replacement using five variables: valve replacement surgery combined with coronary artery bypass graft, previous renal failure, presence of NYHA class III/IV heart failure, age > 70 years and ejection fraction < 50 %, being a simple score, with good performance and adapted to the Brazilian reality. |
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Bodanese, Luiz Carloshttp://lattes.cnpq.br/5570299140032845http://lattes.cnpq.br/8988755869271928Gasperi, Ricardo de2021-09-27T20:19:08Z2021-07-09http://tede2.pucrs.br/tede2/handle/tede/9889Background: Due to population aging, prevalence of aortic stenosis and limited number of scores in the literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. Objective: To construct a clinical death risk score from the data of patients with aortic stenosis submitted to valve replacement surgery. Methods: Observational study of historical cohort. Data collected from 802 patients with aortic stenosis who underwent valve replacement at the São Lucas Hospital of PUCRS between January 1996 and July 2018 were analyzed. Through the aid of multiple logistic regression in a forward stepwise process, a weighted risk score was built based on the magnitude of the coefficients ß of the logistic equation. When they were transformed (exp [ß]) into odds ratios (odds ratios), the values have been rounded up to the whole number using the truncation process to compose the final score. Two performance statistics were obtained: statistic c (area under the ROC curve) and the Hosmer-Lemeshow chi-square of goodness-of-fit with the Pearson correlation coefficient between the observed events and those predicted by the model. Results: The risk predictors that made up the score were: valve replacement surgery combined with coronary artery bypass graft, prior renal failure, presence of NYHA III/IV class heart failure, age greater than 70 years and ejection fraction less than 50%. The area under the ROC curve was 0.77 (CI: 95%, 0.72-0.82). The risk model showed good ability for observed / predicted mortality: Hosmer-Lemeshow test was c2 = 3.70 (p = 0.594) and Pearson's coefficient was r = 0.98 (p < 0.001). Conclusion: We propose a risk score for hospital death in patients undergoing aortic valve replacement using five variables: valve replacement surgery combined with coronary artery bypass graft, previous renal failure, presence of NYHA class III/IV heart failure, age > 70 years and ejection fraction < 50 %, being a simple score, with good performance and adapted to the Brazilian reality.Fundamento: Devido ao envelhecimento populacional, prevalência da estenose aórtica e limitado número de escores na literatura, é essencial desenvolver escores de risco adaptados à nossa realidade e criados no âmbito específico desta doença. Objetivo: Construir um escore de risco de óbito cirúrgico a partir dos dados de pacientes com estenose aórtica submetidos à cirurgia de troca valvar. Métodos: Estudo observacional de coorte histórica. Foram analisados dados coletados de 802 pacientes com estenose aórtica submetidos à troca valvar no Hospital São Lucas da PUCRS entre janeiro de 1996 a julho de 2018. Através do auxílio da regressão logística múltipla em processo de forward stepwise, foi construído um escore de risco ponderado baseado na magnitude dos coeficientes ß da equação logística. Ao serem transformados (exp [ß]) em odds ratio (razão de chances), os valores foram arredondados para o número inteiro através do processo de truncagem para compor o escore final. Foram obtidas duas estatísticas de desempenho: estatística c (área sob a curva ROC) e o qui-quadrado de adequação de ajuste (goodness-of-fit) de Hosmer-Lemeshow com o coeficiente de correlação de Pearson entre os eventos observados e os preditos pelo modelo. Resultados: Os preditores de risco que compuseram o escore foram: cirurgia de troca valvar combinada com cirurgia de revascularização do miocárdio, insuficiência renal prévia, presença de insuficiência cardíaca classes III/IV pela NYHA, idade superior a 70 anos e fração de ejeção menor que 50%. A área obtida sob a curva ROC foi 0,77 (IC: 95%, 0,72 - 0,82). O modelo de risco mostrou boa habilidade para mortalidade observada/prevista: teste Hosmer- Lemeshow foi c2 = 3,70 (p = 0,594) e o coeficiente de Pearson foi r = 0,98 (p < 0,001). Conclusão: Propomos um escore de risco de óbito hospitalar em pacientes submetidos à troca valvar aórtica através de cinco variáveis: cirurgia de troca valvar combinada com cirurgia de revascularização do miocárdio, insuficiência renal prévia, presença de insuficiência cardíaca classes III/IV pela NYHA, idade > 70 anos e fração de ejeção < 50%, sendo um escore simples, com bom desempenho e adaptado à realidade brasileira.Submitted by PPG Medicina e Ciências da Saúde (medicina-pg@pucrs.br) on 2021-09-24T16:58:58Z No. of bitstreams: 1 TESE RicardoGasperi.pdf: 1062753 bytes, checksum: f72a8df67af1d120964a29db8ec5640d (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2021-09-27T20:12:11Z (GMT) No. of bitstreams: 1 TESE RicardoGasperi.pdf: 1062753 bytes, checksum: f72a8df67af1d120964a29db8ec5640d (MD5)Made available in DSpace on 2021-09-27T20:19:08Z (GMT). No. of bitstreams: 1 TESE RicardoGasperi.pdf: 1062753 bytes, checksum: f72a8df67af1d120964a29db8ec5640d (MD5) Previous issue date: 2021-07-09application/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/182179/TES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina e Ciências da SaúdePUCRSBrasilEscola de MedicinaFatores de RiscoEstenose AórticaValvas Cardíacas/CirurgiaRisk FactorsAortic Valve StenosisHeart Valves/SurgeryCIENCIAS DA SAUDE::MEDICINAProposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvarinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTrabalho será publicado como artigo ou livro60 meses27/09/2026-721401722658532398500500500-224747486637135387-969369452308786627info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAILTES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.jpgTES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.jpgimage/jpeg4071http://tede2.pucrs.br/tede2/bitstream/tede/9889/4/TES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.jpg52cb4f6bb9ba2794fe198870b8f9f4bdMD54TEXTTES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.txtTES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.txttext/plain1706http://tede2.pucrs.br/tede2/bitstream/tede/9889/3/TES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdf.txt8d271c0f1302e8bc3b78fe5e9a82ee42MD53ORIGINALTES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdfTES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdfapplication/pdf454078http://tede2.pucrs.br/tede2/bitstream/tede/9889/2/TES_RICARDO_DE_GASPERI_CONFIDENCIAL.pdfef43b5ec01da0585f3013e7b5c2a5d85MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8590http://tede2.pucrs.br/tede2/bitstream/tede/9889/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/98892021-09-27 20:00:24.582oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2021-09-27T23:00:24Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
title |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
spellingShingle |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar Gasperi, Ricardo de Fatores de Risco Estenose Aórtica Valvas Cardíacas/Cirurgia Risk Factors Aortic Valve Stenosis Heart Valves/Surgery CIENCIAS DA SAUDE::MEDICINA |
title_short |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
title_full |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
title_fullStr |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
title_full_unstemmed |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
title_sort |
Proposta de escore de risco cirúrgico em pacientes com estenose aórtica submetidos à cirurgia de troca valvar |
author |
Gasperi, Ricardo de |
author_facet |
Gasperi, Ricardo de |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Bodanese, Luiz Carlos |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/5570299140032845 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/8988755869271928 |
dc.contributor.author.fl_str_mv |
Gasperi, Ricardo de |
contributor_str_mv |
Bodanese, Luiz Carlos |
dc.subject.por.fl_str_mv |
Fatores de Risco Estenose Aórtica Valvas Cardíacas/Cirurgia |
topic |
Fatores de Risco Estenose Aórtica Valvas Cardíacas/Cirurgia Risk Factors Aortic Valve Stenosis Heart Valves/Surgery CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
Risk Factors Aortic Valve Stenosis Heart Valves/Surgery |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
Background: Due to population aging, prevalence of aortic stenosis and limited number of scores in the literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. Objective: To construct a clinical death risk score from the data of patients with aortic stenosis submitted to valve replacement surgery. Methods: Observational study of historical cohort. Data collected from 802 patients with aortic stenosis who underwent valve replacement at the São Lucas Hospital of PUCRS between January 1996 and July 2018 were analyzed. Through the aid of multiple logistic regression in a forward stepwise process, a weighted risk score was built based on the magnitude of the coefficients ß of the logistic equation. When they were transformed (exp [ß]) into odds ratios (odds ratios), the values have been rounded up to the whole number using the truncation process to compose the final score. Two performance statistics were obtained: statistic c (area under the ROC curve) and the Hosmer-Lemeshow chi-square of goodness-of-fit with the Pearson correlation coefficient between the observed events and those predicted by the model. Results: The risk predictors that made up the score were: valve replacement surgery combined with coronary artery bypass graft, prior renal failure, presence of NYHA III/IV class heart failure, age greater than 70 years and ejection fraction less than 50%. The area under the ROC curve was 0.77 (CI: 95%, 0.72-0.82). The risk model showed good ability for observed / predicted mortality: Hosmer-Lemeshow test was c2 = 3.70 (p = 0.594) and Pearson's coefficient was r = 0.98 (p < 0.001). Conclusion: We propose a risk score for hospital death in patients undergoing aortic valve replacement using five variables: valve replacement surgery combined with coronary artery bypass graft, previous renal failure, presence of NYHA class III/IV heart failure, age > 70 years and ejection fraction < 50 %, being a simple score, with good performance and adapted to the Brazilian reality. |
publishDate |
2021 |
dc.date.accessioned.fl_str_mv |
2021-09-27T20:19:08Z |
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2021-07-09 |
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http://tede2.pucrs.br/tede2/handle/tede/9889 |
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por |
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por |
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-721401722658532398 |
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500 500 500 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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Programa de Pós-Graduação em Medicina e Ciências da Saúde |
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PUCRS |
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Brasil |
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Escola de Medicina |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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