Derivation and validation of a practical risk score for prediction of mortality after open repair of ruptured abdominal aortic aneurysms in a U.S. regional cohort and comparison to existing scoring systems

Robinson WP, Schanzer A, Li Y, et al (Univ of Massachusetts Med School and UMass Memorial Med Ctr, Worcester; et al) J Vasc Surg 57:354-361, 2013^§

Abstract

Objective

Scoring systems for predicting mortality after repair of ruptured abdominal aortic aneurysms (RAAAs) have not been developed or tested in a United States population and may not be accurate in the endovascular era. Using prospectively collected data from the Vascular Study Group of New England (VSGNE), we developed a practical risk score for in-hospital mortality after open repair of RAAAs and compared its performance to that of the Glasgow aneurysm score, Hardman index, Vancouver score, and Edinburg ruptured aneurysm score.

Methods

Univariate analysis followed by multivariable analysis of patient, prehospital, anatomic, and procedural characteristics identified significant predictors of in-hospital mortality. Integer points were derived from the odds ratio (OR) for mortality based on each independent predictor in order to generate a VSGNE RAAA risk score, which was internally validated using bootstrapping methodology. Discrimination and calibration of all models were assessed by calculating the area under the receiver-operating characteristic curve (C-statistic) and applying the Hosmer-Lemeshow test.

Results

From 2003 to 2009, 242 patients underwent open repair of RAAAs at 10 centers. In-hospital mortality was 38% (n = 91). Independent predictors of mortality included age > 76 years (OR, 5.3; 95% confidence interval [CI], 2.8-10.1), preoperative cardiac arrest (OR, 4.3; 95% CI, 1.6-12), loss of consciousness (OR, 2.6; 95% CI, 1.2-6), and suprarenal aortic clamp (OR, 2.4; 95% CI, 1.3-4.6). Patient stratification according to the VSGNE RAAA risk score (range, 0-6) accurately predicted mortality and identified those at low and high risk for death (8%, 25%, 37%, 60%, 80%, and 87% for scores of 0, 1, 2, 3, 4, and ≥5, respectively). Discrimination (C = .79) and calibration (χ² = 1.96; P = .85) were excellent in the derivation and bootstrap samples and superior to that of existing scoring systems. The Glasgow aneurysm score, Hardman index, Vancouver score, and Edinburg ruptured aneurysm score correlated with mortality in the VSGNE cohort but failed to identify accurately patients with a risk of mortality > 65%.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Muscle Adaptation in Response to Supervised Exercise Training for Intermittent Claudication
2. Follow-Up of Endovascular Treatment for Trans-Atlantic Inter-Society Consensus II Type B Iliac Lesions in Patients Aged <50 Years
3. of Gender and Age on Outcomes of Tibial Artery Endovascular Interventions in Critical Limb Ischemia
4. influence of metabolic syndrome on hemodialysis access patency

Stay updated, free articles. Join our Telegram channel

Join