Simplified Acute Physiology Score 2 As Outcome’S Predictor For Tavi: A Single-center Experience In 599 Patients
Francesco Pollari1, Michela Cuomo1, Claudius Söhn2, Jill Marianowicz2, Pia Wiehofsky2, Jürgen Jessl3, Ferdinand Vogt1, Theodor Fischlein1, Steffen Pfeiffer1.
1Cardiac surgery, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany, 2Paracelsus Medical University Nuremberg, Nuremberg, Germany, 3Cardiology, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany.
OBJECTIVE: Simplified Acute Physiology Score (SAPS) 2 is a prognostic score for predicting outcome of critically ill patients on admission in intensive care units (ICU). Our aim is to assess its utility in Transcatheter aortic valve implantation (TAVI) patients.
METHODS: We retrospectively analyzed data from patients, who underwent a TAVI procedure from 2010 up to October 2016. Patients who survived TAVI were extubated in the hybrid room according to our fast track protocol and thereafter admitted to intensive care unit, where SAPS2 was prospectively calculated. Outcomes (length of ICU-, hospital-stay and 30-day mortality) were measured in transfemoral (TF) and in transapical (TA) groups, separately. A Pearson’s test of linear correlation was applied. Discrimination and goodness-of-fit for predicting 30-days mortality were assessed through Receiver-Operating Characteristic (ROC) curve and Hosmer-Lemeshow test, respectively.
RESULTS: 699 TAVI procedures were performed in 696 patients (mean age 81.6±6 years, 52% females, mean logistic Euroscore I 25.08%±15.87). For 599, SAPS2 was disposable (mean 30.33±14.3; range 12-101). 229 patients underwent TA-TAVI (age 81.65±5.9 years) and 370 underwent TF-TAVI (age 81.71±6.1 years). Logistic Euroscore in TA group was significantly higher than in TF group (29.66%±16.1 vs 22.59%±15.16, p<0.05, test T student). In the TA group, mean SAPS2 was 29.73±11.27 (range 13-101) with an observed 30-day mortality of 7%. Mean ICU and hospital stay were 3.98±6.6 and 14.28±8.85 days respectively. Pearson’s test showed a significant correlation between SAPS2 and hospital-stay (p=0.03; R statistic 0.148), but no statistical significance with ICU-stay and 30-day-mortality (p>0.05). In the TF group mean SAPS2 was 30.82±11.27 (range 12-98) with an observed 30-day mortality of 2.7%. Mean ICU- and hospital-stay were 1.63±3 and 11.33±8.14 days respectively. Pearson’s test showed no significant correlation between SAPS2 and 30-day-mortality (p=0.35), ICU- (p=0.25) and hospital-stay (p=0.06). Hosmer-Lemeshow test was not significant in both groups, meaning a good calibration, but ROC curve showed a very poor discrimination (TF group χ2=2.73, p=0.95; area under curve=0.594±0.089, 95%-CI:0.418-0.769 - TA group χ2=6.829, p=0.447; area under curve=0.587±0.068, 95%-CI:0.455-0.720).
CONCLUSIONS: SAPS2 does not correlate with 30-days-mortality and ICU stay in TAVI patients. A correlation between SAPS2 and hospital-stay has been found only in TA-TAVI patients.
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