Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery
Abstract
:1. Background
2. Materials and Methods
2.1. Statistical Analysis
2.2. Sample Size Calculation
3. Results
3.1. In-Hospital Mortality Predictive Models
3.1.1. Preoperative Model
3.1.2. Surgery Model
3.1.3. ICU Model
3.2. Postoperative NIMV Predictive Models
3.2.1. Preoperative/Surgery Model
3.2.2. ICU Model
3.3. Postoperative Pulmonary Complication Predictive Model
3.3.1. Preoperative Model
3.3.2. Surgery Model
3.4. ROC Curve Analysis of the PaO2/FiO2 Ratio
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Training Set (7448 (66%) Cases) | Test Set (3837 (34%) Cases) |
---|---|---|
Age, yrs | 67.98 ± 14.00 | 67.59 ± 13.98 |
Male sex, n (%) | 4394 (59%) | 2302 (60%) |
BMI, kg/m2 | 25.45 ± 3.97 | 25.46 ± 3.00 |
Preoperative EF, % | 56.23 ± 9.00 | 56.19 ± 9.99 |
NYHA class > II, n (%) | (28.20%) | 1082 (28.20%) |
Preoperative comorbidities | ||
COPD, n (%) | 476 (6.39%) | 252 (6.56%) |
Hypertension, n (%) | 3706 (49.75%) | 2003 (52.19%) |
Type II Diabetes, n (%) | 779 (10.46%) | 426 (11.10%) |
Preoperative creatinine, mg/dL | 0.98 ± 0.68 | 0.98 ± 0.66 |
Chronic renal failure, n (%) | 1418 (19%) | 789 (20%) |
Peripheral vasculopathy, n (%) | 1089 (14.63%) | 518 (13.50%) |
Smoking habits, n (%) | 1,279,504 (17.17%) | 653 (17.01%) |
Stroke, n (%) | (6.76%) | 279 (7.27%) |
Timing of surgery | ||
Emergency or urgency, n (%) | 63 (0.85%) | 32 (0.85%) |
Planned, n (%) | 7385 (99.15%) | 3805 (99.15%) |
Type of surgery | ||
Valvular surgery, n (%) | 2944 (39.53%) | 1535 (39.99%) |
Coronary surgery, n (%) | 991 (13.30%) | 476 (12.42%) |
Ascending aorta aneurysm surgery, n (%) | 236 (3.17%) | 106 (2.77%) |
Other surgical procedures, n (%) | 343 (4.60%) | 172 (4.48%) |
Combined surgery (two or more procedures), n (%) | 2934 (39.40%) | 1548 (40.35%) |
Variable | Preoperative Value |
---|---|
Age, y | 67.55 ± 13.97 |
Male sex, n (%) | 9844 (87.2%) |
Height, cm | 169 ± 9 |
Weight, kg | 73 ± 13 |
BMI, kg/m2 | 25.46 ± 3.95 |
Preoperative EF, % | 56.41% ± 9.77 |
NYHA class > II, n (%) | |
Preoperative comorbidities | |
COPD, n (%) | 920 (8.1%) |
Hypertension, n (%) | 7.248 (64.2%) |
Type II Diabetes, n (%) | 1.528 (13.5%) |
Preoperative creatinine, mg/dL | 0.98 ± 0.67 |
Chronic renal failure, n (%) | 1161 (10.2%) |
Peripheral vasculopathy, n (%) | 2036 (18.0%) |
Smoking habits, n (%) | 2443 (21.6%) |
Stroke, n (%) | 989 (8.8%) |
Timing of surgery | |
Emergency or urgency, n (%) | 214 (1.9%) |
Planned, n (%) | 11,071 (98.1%) |
Surgery type | |
Valvular surgery, n (%) | 5178 (45.88%) |
Coronary surgery, n (%) | 1814 (16.07%) |
Ascending aorta aneurysm surgery, n (%) | 420 (3.71%) |
Other surgical procedures, n (%) | 999 (8.85%) |
Combined surgery (two or more procedures), n (%) | 5564 (49.31%) |
Models for Mortality | Models for NIMV | Models for PPC | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Preoperative models | Predictive Variable | Odds Ratio | 95% CI | p-Value | Predictive Variable | Odds Ratio | 95% CI | p-Value | Predictive Variable | Odds Ratio | 95% CI | p-Value |
Age | 1.05 | 1.02–1.08 | <0.001 | Age | 1.04 | 1.02–1.06 | <0.001 | COPD | 2.63 | 1.31–5.28 | 0.007 | |
Preoperative EF | 0.97 | 0.95–0.99 | 0.011 | Preoperative EF | 0.97 | 0.96–1.00 | 0.023 | Creatinine | 1.48 | 1.19–1.83 | <0.001 | |
NYHA class | 2.97 | 1.63–5.41 | <0.001 | BMI | 1.10 | 1.05–1.15 | <0.001 | EF | 0.97 | 0.95–0.99 | 0.004 | |
Elective surgery | 0.29 | 0.90–0.91 | 0.036 | Preoperative Creatinine | 1.26 | 1.01–1.58 | 0.043 | NYHA class | 1.81 | 1.05–3.14 | 0.033 | |
Random effect variable | SD | SE | p | Random effect variable | SD | SE | p | Random effect variable | SD | SE | p | |
Year of surgery | <0.001 | 0.37 | 1.000 | Year of surgery | 0.53 | 0.18 | <0.001 | Year of surgery | 0.28 | 0.20 | 0.176 | |
Surgery models | Predictive Variable | Odds Ratio | 95% CI | p-Value | Predictive Variable | Odds Ratio | 95% CI | p-Value | Predictive Variable | Odds Ratio | 95% CI | p-Value |
Inotropes in the operating room | 3.09 | 1.45–6.6 | 0.003 | Age | 1.04 | 1.02–1.06 | <0.001 | Inotropes in the operating room | 2.79 | 1.38–5.64 | 0.004 | |
IABP in the operating room | 3.91 | 1.90–8.04 | <0.001 | Preoperative EF | 0.97 | 0.96–1.00 | 0.023 | IABP in the operating room | 2.64 | 1.02–6.81 | 0.045 | |
Age | 1.06 | 1.03–1.10 | <0.001 | BMI | 1.10 | 1.05–1.15 | <0.001 | COPD | 3.74 | 1.64–8.51 | 0.002 | |
NYHA class | 2.35 | 1.24–4.47 | 0.009 | Preoperative Creatinine | 1.26 | 1.01–1.58 | 0.043 | Preoperative creatinine | 1.39 | 1.07–1.81 | 0.014 | |
Elective surgery | 0.22 | 0.08–0.65 | 0.006 | |||||||||
Random effect variable | SD | SE | p | Random effect variable | SD | SE | p | Random effect variable | SD | SE | p | |
Year of surgery | 0.24 | 0.30 | 0.320 | Year of surgery | 0.53 | 0.18 | <0.001 | Year of surgery | 0.53 | 0.25 | 1.329 | |
ICU models | Predictive Variable | Odds Ratio | 95% CI | p-Value | Predictive Variable | Odds Ratio | 95% CI | p-Value | ||||
Creatinine peak | 1.50 | 1.24–1.82 | <0.001 | Creatinine peak | 1.35 | 1.21–1.51 | <0.001 | |||||
Tracheostomy | 18.08 | 7.14–45.76 | <0.001 | Inotropes | 1.60 | 1.25–2.04 | <0.001 | |||||
Inotropes in the ICU in the ICU | 2.52 | 1.01–5.77 | 0.029 | P/F | 0.99 | 0.991–0.993 | <0.001 | |||||
NYHA class | 2.79 | 1.35–5.78 | 0.006 | Blood transfusion | 2.41 | 1.87–3.13 | <0.001 | |||||
Age | 1.08 | 1.03–1.12 | <0.001 | BMI | 1.07 | 1.05–1.11 | <0.001 | |||||
P/F ratio | 0.1 | 0.99–0.1 | 0.028 | |||||||||
Random effect variable | SD | SE | p | Random effect variable | SD | SE | p | |||||
Year of surgery | <0.001 | 0.44 | 1.000 | Year of surgery | 0.83 | 0.18 | <0.001 |
Outcome | Incidence |
---|---|
Overall mortality, n (%) | 236 (2.1%) |
Postoperative pulmonary complications, n (%) | 213 (1.9%) |
Postoperative pulmonary complications (including the use of NIMV), n (%) | 821 (7.3%) |
Need for NIMV before hospital discharge, n (%) | 609 (5.4%) |
Re-intubation, n (%) | 97 (0.86%) |
Inotropes, n (%) | 3809 (33.75%) |
Intra-aortic balloon pump, n (%) | 395 (3.5%) |
Blood products, n (%) | 2834 (18%) |
Renal replacement therapy, n (%) | 175 (1.55%) |
VA-ECMO support, n (%) | 12 (0.1%) |
Septic shock, (%) | 56 (0.5%) |
Length of ICU stay, days | 1 (1–3) |
Length of hospital stay, days | 6 (5–8) |
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Bignami, E.; Guarnieri, M.; Giambuzzi, I.; Trumello, C.; Saglietti, F.; Gianni, S.; Belluschi, I.; Di Tomasso, N.; Corti, D.; Alfieri, O.; et al. Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery. Medicina 2023, 59, 1368. https://doi.org/10.3390/medicina59081368
Bignami E, Guarnieri M, Giambuzzi I, Trumello C, Saglietti F, Gianni S, Belluschi I, Di Tomasso N, Corti D, Alfieri O, et al. Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery. Medicina. 2023; 59(8):1368. https://doi.org/10.3390/medicina59081368
Chicago/Turabian StyleBignami, Elena, Marcello Guarnieri, Ilaria Giambuzzi, Cinzia Trumello, Francesco Saglietti, Stefano Gianni, Igor Belluschi, Nora Di Tomasso, Daniele Corti, Ottavio Alfieri, and et al. 2023. "Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery" Medicina 59, no. 8: 1368. https://doi.org/10.3390/medicina59081368