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Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms
BACKGROUND: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) f...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246487/ https://www.ncbi.nlm.nih.gov/pubmed/25403513 http://dx.doi.org/10.1186/1471-2482-14-92 |
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author | Krenzien, Felix Matia, Ivan Wiltberger, Georg Hau, Hans-Michael Schmelzle, Moritz Jonas, Sven Kaisers, Udo X Fellmer, Peter T |
author_facet | Krenzien, Felix Matia, Ivan Wiltberger, Georg Hau, Hans-Michael Schmelzle, Moritz Jonas, Sven Kaisers, Udo X Fellmer, Peter T |
author_sort | Krenzien, Felix |
collection | PubMed |
description | BACKGROUND: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. METHODS: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. RESULTS: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). CONCLUSION: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity. |
format | Online Article Text |
id | pubmed-4246487 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42464872014-12-02 Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms Krenzien, Felix Matia, Ivan Wiltberger, Georg Hau, Hans-Michael Schmelzle, Moritz Jonas, Sven Kaisers, Udo X Fellmer, Peter T BMC Surg Research Article BACKGROUND: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. METHODS: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. RESULTS: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). CONCLUSION: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity. BioMed Central 2014-11-18 /pmc/articles/PMC4246487/ /pubmed/25403513 http://dx.doi.org/10.1186/1471-2482-14-92 Text en © Krenzien et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Krenzien, Felix Matia, Ivan Wiltberger, Georg Hau, Hans-Michael Schmelzle, Moritz Jonas, Sven Kaisers, Udo X Fellmer, Peter T Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
title | Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
title_full | Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
title_fullStr | Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
title_full_unstemmed | Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
title_short | Early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
title_sort | early prediction of survival after open surgical repair of ruptured abdominal aortic aneurysms |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246487/ https://www.ncbi.nlm.nih.gov/pubmed/25403513 http://dx.doi.org/10.1186/1471-2482-14-92 |
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