OBJECTIVES The aim of this study was to externally validate a lab-based risk score (lactate, creatinine, aspartate aminotransferase, alanine aminotransferase or bilirubin) by Ghoreishi et al. to predict perioperative mortality in patients undergoing surgical repair for acute type A aortic dissection. METHODS The risk score to predict operative mortality was applied to a large and homogenous validation cohort that consisted of 632 patients undergoing surgery for acute type A aortic dissection in 2 centres. Multivariable regression analysis was performed to determine the impact on survival. Receiver operating characteristics with deduced area under the curve were used to assess the ability to predict perioperative mortality. RESULTS A total of 632 patients (54% male, mean age 62 ± 14 years) were assigned to 3 different risk groups according to the calculated mortality score [low risk <7 (31.2%), moderate risk 7–20 (36.1%) and high >20 (32.7%)]. Perioperative mortality was 8% in the low-risk group, 10% in the moderate-risk group and 24% in the high-risk group (P < 0.0001). Receiver operating characteristic analysis of this new score revealed an area under the curve of 0.69 with adequate calibration. In addition, multivariable analysis revealed an independet assocation with perioperative mortality (odds ratio 1.509; 95% confidence interval 1.042–2.185). While overall survival differed between the risk groups (P < 0.0001), the score does not serve as an independent predictor of long-term mortality when adjusted for relevant covariates. CONCLUSIONS The external validation process confirmed that a newly proposed risk score offers clinicians a helpful and reliable tool to improve the preoperative risk assessment of acute type A aortic dissection patients based on easily accessible and broadly available laboratory parameters.

中文翻译：

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验证一种新的风险评分来预测急性 A 型夹层术后死亡率

目的 本研究的目的是从外部验证 Ghoreishi 等人基于实验室的风险评分（乳酸、肌酐、天冬氨酸氨基转移酶、丙氨酸氨基转移酶或胆红素）。预测急性 A 型主动脉夹层手术修复患者的围手术期死亡率。方法 将预测手术死亡率的风险评分应用于一个大型且同质的验证队列，该队列由 2 个中心的 632 名接受急性 A 型主动脉夹层手术的患者组成。进行多变量回归分析以确定对生存的影响。使用曲线下面积推断的受试者工作特征来评估预测围手术期死亡率的能力。结果 共有 632 名患者（54% 男性，平均年龄 62 ± 14 岁）根据计算的死亡率评分被分配到 3 个不同的风险组 [低风险 <7 (31.2%)、中等风险 7-20 (36.1%) 和高风险 >20 (32.7%)] . 低危组围手术期死亡率为 8%，中危组为 10%，高危组为 24%（P < 0.0001）。对这一新分数的接受者操作特征分析显示，曲线下面积为 0.69，并具有足够的校准。此外，多变量分析显示与围手术期死亡率存在独立关联（优势比 1.509；95% 置信区间 1.042-2.185）。虽然风险组之间的总生存期不同（P < 0.0001），但在调整相关协变量后，该分数不能作为长期死亡率的独立预测因子。