Risk Stratification of Ruptured Abdominal Aortic Aneurysms in Patients Treated by Open Surgical Repair

F Krenzien; G Wiltberger; H-M Hau; I Matia; C Benzing; G Atanasov; M Schmelzle; P T Fellmer

doi:10.1016/j.ejvs.2015.07.003

Risk Stratification of Ruptured Abdominal Aortic Aneurysms in Patients Treated by Open Surgical Repair

Eur J Vasc Endovasc Surg. 2016 Jan;51(1):30-6. doi: 10.1016/j.ejvs.2015.07.003. Epub 2015 Aug 5.

Authors

F Krenzien¹, G Wiltberger², H-M Hau², I Matia², C Benzing², G Atanasov², M Schmelzle², P T Fellmer²

Affiliations

¹ Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany; Transplant Surgery Research Laboratory and Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: fekrenzien@gmail.com.
² Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.

PMID: 26254832
DOI: 10.1016/j.ejvs.2015.07.003

Abstract

Objective: The present study tested scoring models for ruptured abdominal aortic aneurysms (rAAAs) in patients treated by open surgical repair (OSR). Scores were tested in a European population to validate their applicability for predicting outcome.

Methods: Between 2002 and 2013, 92 patients with rAAAs underwent OSR and medical records were reviewed retrospectively. The Edinburgh Rupture Aneurysm Score (ERAS), Vascular Study Group of New England (VSGNE) rAAA risk score, Hardman Index, and Glasgow Aneurysm Score (GAS) were calculated and analyzed according to in hospital mortality. The discriminatory power and calibration of all models were assessed by applying the receiver operating characteristic and the Hosmer-Lemeshow test χ(2).

Results: An ERAS ≤ 1 (n = 55), 2 (n = 15) and 3 (n = 16) was associated with a mortality of 27%, 47%, and 69%, respectively. The calibration was the best of all tested scores (χ(2) = 0.44; p = .81) and the area under the curve (AUC) was 0.71 (95% CI 0.6-0.82; p = .001). A VSGNE rAAA risk score = 0 (n = 19), 1 (n = 15), 2 (n = 19), 3 (n = 25), and ≥ 4 (n = 9) was associated with a mortality of 11%, 20%, 32%, 72%, and 56%, and an AUC of 0.76 (95% CI 0.66-0.87; p = .001). The calibration was reduced (χ(2) = 6.9; p = .08). The GAS and Hardman Index increased stepwise with increasing in hospital mortality, but were inferior to ERAS and the VSGNE rAAA risk score. The Hardman Index showed the smallest AUC (0.68; 95% CI 0.56-0.80; p = .011) and demonstrated a lack of fit (χ(2) = 8.2; p = .04). The GAS showed good discrimination (AUC = 0.75; 95% CI 0.64-0.85; p < .001) and calibration (χ(2) = 0.85; p = .66); however, the parametric scale of GAS limits its use to classifying patients according to their risk.

Conclusion: The present study revealed remarkable differences in survival between subgroups (10-70%) and underscores the need for risk stratification. The ERAS was favorable with striking ease of use and high accuracy in predicting outcome.

Keywords: Abdominal; Aortic rupture; Classification; Mortality; Scoring methods.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / diagnosis
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / surgery*
Aortic Rupture / diagnosis
Aortic Rupture / mortality
Aortic Rupture / surgery*
Area Under Curve
Chi-Square Distribution
Decision Support Techniques*
Female
Germany
Hospital Mortality
Humans
Logistic Models
Male
Medical Records
Multivariate Analysis
Patient Selection
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects
Vascular Surgical Procedures* / mortality