Key result
A novel nomogram model incorporating inflammatory, nutritional, and perioperative factors yielded better discrimination for 1-year mortality than EuroSCORE II alone (C-index 0.834 vs 0.744; P<0.001).
Why the study?
Existing cardiac surgery risk-scoring systems lack nutritional, inflammatory, and intraoperative factors, prompting the development of a comprehensive mortality prediction model for valvular heart surgery.
Does a nomogram model incorporating nutritional, inflammatory, and perioperative factors improve prediction of 1-year mortality after valvular heart surgery compared to EuroSCORE II alone?
Cohort (n=2,046)
Yes
Does a nomogram model incorporating nutritional, inflammatory, and perioperative factors improve prediction of 1-year mortality after valvular heart surgery compared to EuroSCORE II alone?
Effect estimate: C-index 0.834 (95% CI 0.791-0.877)
Absolute Event Rate: 0.834% vs 0.744%
p-value: p=<0.001
A novel nomogram integrating inflammatory, nutritional, and perioperative factors with EuroSCORE II improves the prediction of 1-year mortality after valvular heart surgery compared to EuroSCORE II alone.
May enhance mortality prediction in valvular surgery; leaves open prospective validation before clinical adoption.
INTRODUCTION: Existing risk-scoring systems for cardiac surgery include only standard preoperative factors without considering nutritional and inflammatory status or intraoperative factors. The objective of this study was to develop a comprehensive prediction model for mortality incorporating nutritional, inflammatory, and perioperative factors in patients undergoing valvular heart surgery. MATERIALS AND METHODS: In this retrospective review of 2046 patients who underwent valvular heart surgery, Cox and LASSO regression analyses were performed to identify independent prognostic factors for 1-year postoperative mortality among various perioperative factors known to affect prognosis, including objective nutritional and inflammatory indices. A novel nomogram model incorporating selected prognostic factors was developed, and its discrimination ability was evaluated using the C-index. The model was validated in internal and external cohorts. RESULTS: The 1-year mortality rate after valvular heart surgery was 5.1% (105 of 2046 patients) and was significantly associated with several preoperative objective inflammatory and nutritional indices. Cox and LASSO analyses identified the following five independent prognostic factors for mortality: monocyte-to-lymphocyte ratio (an objective inflammatory index), EuroSCORE II, Controlling Nutritional Status score, cardiopulmonary bypass time, and number of erythrocyte units transfused intraoperatively. The nomogram model incorporating these five factors had a C-index of 0.834 (95% CI: 0.791-0.877), which was higher than that of EuroSCORE II alone (0.744, 95% CI: 0.697-0.791) ( P <0.001). The nomogram achieved good discrimination ability, with C-indices of 0.836 (95% CI: 0.790-0.878) and 0.727 (95% CI: 0.651-0.803) in the internal and external validation cohorts, respectively, and showed well-fitted calibration curves. CONCLUSIONS: A nomogram model incorporating five inflammatory, nutritional, and perioperative factors, as well as EuroSCORE II, was a better predictor of 1-year mortality after valvular heart surgery than EuroSCORE II alone, with good discrimination and calibration power for predicting mortality in both internal and external validation cohorts.
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Cho et al. (2023) conducted a cohort in valvular heart surgery (n=2,046). Novel nomogram model (monocyte-to-lymphocyte ratio, EuroSCORE II, Controlling Nutritional Status score, cardiopulmonary bypass time, intraoperative erythrocyte units) vs. EuroSCORE II alone was evaluated on Discrimination ability (C-index) for 1-year postoperative mortality (C-index 0.834, 95% CI 0.791-0.877, p=<0.001). A novel nomogram model incorporating inflammatory, nutritional, and perioperative factors yielded better discrimination for 1-year mortality than EuroSCORE II alone (C-index 0.834 vs 0.744; P<0.001).
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