Predictive value of serum prealbumin combined with SinoSCORE for patients undergoing heart valve replacement

AIM To evaluate the supplementary predictive value of serum prealbumin combined with SinoSCORE model for heart valve replacement.

METHODS Perioperative data of 415 patients undergoing heart valve replacement at our department from July 2017 to August 2019 were retrospectively analyzed. The patients were divided into two groups based on their preoperative serum prealbumin levels (PA<200 mg/L and PA≥200 mg/L), Actual mortality rate and predicted mortality rate of the two groups were compared. The association between serum prealbumin and postoperative death was examined by logistic regression analysis and the supplementary predictive value of prealbumin was comprehensively evaluated by calculating the area under the receiver operating characteristic curve (AUC), the net reclassification index (NRI) and the integrated discrimination index (IDI).

RESULTS The mortality rate of patients in the reduced prealbumin group was significantly higher than that in normal prealbumin group (P<0.01), the 30-day postoperative mortality (including death after against advice discharge from hospital) was 13.20% and 4.63%, respectively. No statistically significant difference between the two groups was found in the predicted mortality of SinoSCORE . Univariate logistic regression analysis showed negative correlation between prealbumin levels and postoperative death (OR=0.989, P<0.01). Area under the ROC curve (AUC) of SinoSCORE combined with prealbumin increased by 0.091, and there was significant statistical difference in predicting mortality compared with the area under the ROC curve (AUC) of SinoSCORE alone (P<0.01). Net reclassification index (NRI) and integrated discrimination index (IDI) of SinoSCORE combined with prealbumin were 0.092 and 0.023.

CONCLUSION Serum prealbumin has a good supplementary predictive value for SinoSCORE model in predicting the risk of death in patients undergoing heart valve replacement. Therefore, serum prealbumin can be included as an important predictor in the new heart valve surgery risk scoring model established in the future.