A postoperative in-hospital mortality risk model for elderly patients undergoing cardiac valvular surgery based on LASSO-logistic regression_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Kun , LIN Hongyuan , GONG Jiamiao , AN Kang , ZHENG Zhe ,  HOU Jianfeng

Department of Adult Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

HOU Jianfeng, Email: hjf2006111@163.com

Keywords：

Valvular heart disease; mortality risk; prediction model; LASSO-logistic regression

DOI：

10.7507/1007-4848.202301032

Video：

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Objective To evaluate the risk factors for postoperative in-hospital mortality in elderly patients receiving cardiac valvular surgery, and develop a new prediction models using the least absolute shrinkage and selection operator (LASSO)-logistic regression. Methods The patients≥65 years who underwent cardiac valvular surgery from 2016 to 2018 were collected from the Chinese Cardiac Surgery Registry (CCSR). The patients who received the surgery from January 2016 to June 2018 were allocated to a training set, and the patients who received the surgery from July to December 2018 were allocated to a testing set. The risk factors for postoperative mortality were analyzed and a LASSO-logistic regression prediction model was developed and compared with the EuroSCOREⅡ. Results A total of 7 163 patients were collected in this study, including 3 939 males and 3 224 females, with a mean age of 69.8±4.5 years. There were 5 774 patients in the training set and 1389 patients in the testing set. Overall, the in-hospital mortality was 4.0% (290/7163). The final LASSO-logistic regression model included 7 risk factors: age, preoperative left ventricular ejection fraction, combined coronary artery bypass grafting, creatinine clearance rate, cardiopulmonary bypass time, New York Heart Association cardiac classification. LASSO-logistic regression had a satisfying discrimination and calibration in both training [area under the curve (AUC)=0.785, 0.627] and testing cohorts (AUC=0.739, 0.642), which was superior to EuroSCOREⅡ. Conclusion The mortality rate for elderly patients undergoing cardiac valvular surgery is relatively high. LASSO-logistic regression model can predict the risk of in-hospital mortality in elderly patients receiving cardiac valvular surgery.

Citation： ZHU Kun, LIN Hongyuan, GONG Jiamiao, AN Kang, ZHENG Zhe, HOU Jianfeng. A postoperative in-hospital mortality risk model for elderly patients undergoing cardiac valvular surgery based on LASSO-logistic regression. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 35-43. doi: 10.7507/1007-4848.202301032 Copy

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2.	Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol, 2011, 8(3): 162-172.
3.	Ambler G, Omar RZ, Royston P, et al. Generic, simple risk stratification model for heart valve surgery. Circulation, 2005, 112(2): 224-231.
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6.	沈卫峰, 杨震坤. 心脏瓣膜病诊治进展. 中华老年心脑血管病杂志, 2009, 11(12): 905-907.
7.	Jamieson WR, Edwards FH, Schwartz M, et al. Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Database Committee of The Society of Thoracic Surgeons. Ann Thorac Surg, 1999, 67(4): 943-951.
8.	Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg, 1999, 16(1): 9-13.
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11.	朱坤, 林宏远, 唐汉玮, 等. 心脏瓣膜病手术风险评估系统的建立. 中国医刊, 2022, 57(3): 237-240.
12.	Rao C, Zhang H, Gao H, et al. The Chinese Cardiac Surgery Registry: Design and data audit. Ann Thorac Surg, 2016, 101(4): 1514-1520.
13.	Kodali SK, Velagapudi P, Hahn RT, et al. Valvular heart disease in patients≥80 years of age. J Am Coll Cardiol, 2018, 71(18): 2058-2072.
14.	Yadgir S, Johnson CO, Aboyans V, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation, 2020, 141(21): 1670-1680.
15.	Yoshida K, Yoshikawa J, Akasaka T, et al. Problems in the management of elderly patients with valvular heart disease. Jpn Circ J, 1988, 52(5): 466-470.
16.	Xu H, Liu Q, Cao K, et al. Distribution, characteristics, and management of older patients with valvular heart disease in China: China-DVD Study. JACC Asia, 2022, 2(3): 354-365.
17.	Hu Z, Chen S, Du J, et al. An in-hospital mortality risk model for patients undergoing coronary artery bypass grafting in China. Ann Thorac Surg, 2020, 109(4): 1234-1242.
18.	Zhuge RQ, Hou XP, Qi XL, et al. Clinical features and treatment options for mitral regurgitation in elderly inpatients. J Geriatr Cardiol, 2018, 15(6): 428-433.
19.	Nowicki ER, Birkmeyer NJ, Weintraub RW, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg, 2004, 77(6): 1966-1977.
20.	Lin H, Gong J, Wu Y, et al. A comparative study on surgical treatment of valvular heart disease between high-volume cardiac centers in China and STS data. J Cardiovasc Dev Dis, 2022, 9(7): 212.
21.	Salis S, Mazzanti VV, Merli G, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth, 2008, 22(6): 814-822.
22.	Lin H, Chang Y, Guo H, et al. Prediction nomogram for postoperative 30-day mortality in acute type A aortic dissection patients receiving total aortic arch replacement with frozen elephant trunk technique. Front Cardiovasc Med, 2022, 9: 905908.
23.	Ascione R, Lloyd CT, Underwood MJ, et al. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg, 2000, 69(4): 1198-1204.
24.	Murphy GJ, Angelini GD. Side effects of cardiopulmonary bypass: What is the reality? J Card Surg, 2004, 19(6): 481-488.

1. Coffey S, Roberts-Thomson R, Brown A, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol, 2021, 18(12): 853-864.
2. Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol, 2011, 8(3): 162-172.
3. Ambler G, Omar RZ, Royston P, et al. Generic, simple risk stratification model for heart valve surgery. Circulation, 2005, 112(2): 224-231.
4. O'Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 2―Isolated valve surgery. Ann Thorac Surg, 2009, 88(1 Suppl): S23-S42.
5. 马丽媛, 王增武, 樊静, 等. 《中国心血管健康与疾病报告2021》概要. 中国介入心脏病学杂志, 2022, 30(7): 481-496.
6. 沈卫峰, 杨震坤. 心脏瓣膜病诊治进展. 中华老年心脑血管病杂志, 2009, 11(12): 905-907.
7. Jamieson WR, Edwards FH, Schwartz M, et al. Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Database Committee of The Society of Thoracic Surgeons. Ann Thorac Surg, 1999, 67(4): 943-951.
8. Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg, 1999, 16(1): 9-13.
9. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg. 2012, 41(4): 734-44.
10. Zheng Z, Zhang L, Li X, et al. SinoSCORE: A logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population. Front Med, 2013, 7(4): 477-485.
11. 朱坤, 林宏远, 唐汉玮, 等. 心脏瓣膜病手术风险评估系统的建立. 中国医刊, 2022, 57(3): 237-240.
12. Rao C, Zhang H, Gao H, et al. The Chinese Cardiac Surgery Registry: Design and data audit. Ann Thorac Surg, 2016, 101(4): 1514-1520.
13. Kodali SK, Velagapudi P, Hahn RT, et al. Valvular heart disease in patients≥80 years of age. J Am Coll Cardiol, 2018, 71(18): 2058-2072.
14. Yadgir S, Johnson CO, Aboyans V, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation, 2020, 141(21): 1670-1680.
15. Yoshida K, Yoshikawa J, Akasaka T, et al. Problems in the management of elderly patients with valvular heart disease. Jpn Circ J, 1988, 52(5): 466-470.
16. Xu H, Liu Q, Cao K, et al. Distribution, characteristics, and management of older patients with valvular heart disease in China: China-DVD Study. JACC Asia, 2022, 2(3): 354-365.
17. Hu Z, Chen S, Du J, et al. An in-hospital mortality risk model for patients undergoing coronary artery bypass grafting in China. Ann Thorac Surg, 2020, 109(4): 1234-1242.
18. Zhuge RQ, Hou XP, Qi XL, et al. Clinical features and treatment options for mitral regurgitation in elderly inpatients. J Geriatr Cardiol, 2018, 15(6): 428-433.
19. Nowicki ER, Birkmeyer NJ, Weintraub RW, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg, 2004, 77(6): 1966-1977.
20. Lin H, Gong J, Wu Y, et al. A comparative study on surgical treatment of valvular heart disease between high-volume cardiac centers in China and STS data. J Cardiovasc Dev Dis, 2022, 9(7): 212.
21. Salis S, Mazzanti VV, Merli G, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth, 2008, 22(6): 814-822.
22. Lin H, Chang Y, Guo H, et al. Prediction nomogram for postoperative 30-day mortality in acute type A aortic dissection patients receiving total aortic arch replacement with frozen elephant trunk technique. Front Cardiovasc Med, 2022, 9: 905908.
23. Ascione R, Lloyd CT, Underwood MJ, et al. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg, 2000, 69(4): 1198-1204.
24. Murphy GJ, Angelini GD. Side effects of cardiopulmonary bypass: What is the reality? J Card Surg, 2004, 19(6): 481-488.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A postoperative in-hospital mortality risk model for elderly patients undergoing cardiac valvular surgery based on LASSO-logistic regression

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