The role of right ventricular systolic pressure and ARISCAT score in perioperative pulmonary risk assessment
O papel da pressão sistólica do ventrículo direito e da pontuação ARISCAT na avaliação de risco pulmonar perioperatório
Yoshio Tatsuoka, Zili He, Hung-Mo Lin, Andrew P. Notarianni, Zyad J. Carr
Abstract
Background
Postoperative Pulmonary Complications (PPC) are a significant source of increased morbidity and mortality after surgical procedures. Measures to enhance 30-day PPC risk stratification are an area of significant clinical interest, and integrating common preoperative investigations, such as echocardiography, may enhance quantitative risk prediction when combined with clinical score-based systems, particularly for high-risk populations. The authors hypothesized that Right Ventricular Systolic Pressure (RVSP) would significantly enhance the predictive capabilities of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in the prediction of 30-day PPC in a Pulmonary Hypertension (PH) study cohort.
Methods
277 patients with the diagnosis of PH, ARISCAT score, and echocardiography-derived RVSP within 12-months of surgical procedure were analyzed. The primary endpoint was the 59-variable 30-day Agency for Healthcare Research and Quality PPC composite. Secondary endpoints included sub composites of Pneumonia (PNA), Respiratory Failure (RF), Pulmonary Aspiration (ASP) and thromboembolic Phenomenon (PE). Adjusted multivariable logistic regression models followed by Receiver Operating Characteristic Curves (ROC) and Area Under the Curve (AUC) analysis were employed to assess the prediction of 30-day PPC.
Results
Mean RVSP was 52.1 mmHg (±17.4). Overall PPC incidence was 29.9%, with RF (19.5%), PNA (12.3%), ASP (5.4%), and PE (3.6%) composites. Logistic regression showed no significant association between RVSP and PPC (Odds Ratio [OR = 1.01], p = 0.307). The ARISCAT score was associated with 30-day PPC risk (OR = 1.02, p = 0.037). Receiver Operating Characteristic (ROC) curve analysis revealed an Area Under the Curve (AUC) of 0.555 for RVSP alone, 0.575 for the ARISCAT score, and 0.591 for the combination of RVSP+ARISCAT for the primary endpoint.
Conclusion
RVSP demonstrated limited efficacy as a standalone predictor of 30-day PPC in patients with PH. Although integrating RVSP with ARISCAT scoring yielded marginal improvements in predictive accuracy, neither metric, independently or in combination, achieved adequate clinical significance for reliable risk stratification. These findings highlight a critical gap in the current preoperative risk assessment for PH-specific predictive tools. Future research should focus on alternative measures that better capture vulnerability to the hemodynamic complexities underscoring PPC in this high-risk population.
Keywords
Resumo
Introdução
Complicações Pulmonares Pós-Operatórias (CPPO) são uma fonte significativa de aumento de morbidade e mortalidade após procedimentos cirúrgicos. Medidas para melhorar a estratificação de risco de CPPO de 30 dias são uma área de interesse clínico significativo, e integrar investigações pré-operatórias comuns, como ecocardiografia, pode melhorar a previsão quantitativa de risco quando combinada com sistemas baseados em pontuação clínica, particularmente para populações de alto risco. Os autores levantaram a hipótese de que a Pressão Sistólica Ventricular Direita (RVSP) aumentaria significativamente as capacidades preditivas da pontuação Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) na previsão de CPPO de 30 dias em uma coorte de estudo de Hipertensão Pulmonar (HP).
Métodos
Foram analisados 277 pacientes com diagnóstico de HP, pontuação ARISCAT e RVSP derivada de ecocardiografia dentro de 12 meses do procedimento cirúrgico. O desfecho primário foi o composto de 59 variáveis de 30 dias da Agency for Healthcare Research and Quality PPC. Os desfechos secundários incluíram subcompostos de Pneumonia (PNA), Insuficiência Respiratória (IR), Aspiração Pulmonar (ASP) e Fenômeno Tromboembólico (FT). Modelos de regressão logística multivariável ajustados seguidos por Curvas Características de Operação do Receptor (ROC) e análise de Área Sob a Curva (AUC) foram empregados para avaliar a predição de PPC em 30 dias.
Resultados
A RVSP média foi de 52,1 mmHg (±17,4). A incidência geral de PPC foi de 29,9%, com compostos de IR (19,5%), PNA (12,3%), ASP (5,4%) e FT (3,6%). A regressão logística não mostrou associação significativa entre RVSP e PPC (Odds Ratio [OR = 1,01], p = 0,307). O escore ARISCAT foi associado ao risco de PPC em 30 dias (OR = 1,02, p = 0,037). A análise da curva Receiver Operating Characteristic (ROC) revelou uma Área Sob a Curva (AUC) de 0,555 para RVSP sozinho, 0,575 para a pontuação ARISCAT e 0,591 para a combinação de RVSP+ARISCAT para o desfecho primário.
Conclusão
RVSP demonstrou eficácia limitada como um preditor independente de CPPO de 30 dias em pacientes com HP. Embora a integração de RVSP com pontuação ARISCAT tenha produzido melhorias marginais na precisão preditiva, nenhuma métrica, independentemente ou em combinação, alcançou significância clínica adequada para estratificação de risco confiável. Essas descobertas destacam uma lacuna crítica na avaliação de risco pré-operatória atual para ferramentas preditivas específicas de HP. Pesquisas futuras devem se concentrar em medidas alternativas que capturem melhor a vulnerabilidade às complexidades hemodinâmicas que ressaltam a PPC nessa população de alto risco.
Palavras-chave
References
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Submitted date:
07/15/2024
Accepted date:
01/31/2025
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