title: Preoperative risk factors for in-hospital mortality and validity of the Glasgow aneurysm score and Hardman index in patients with ruptured abdominal aortic aneurysm.
abstract: The aim of this study is to evaluate the validity of the Glasgow aneurysm score (GAS) and Hardman index in patients operated on because of ruptured abdominal aortic aneurysm (rAAA), and determining preoperative risk factors that affect in-hospital mortality. One hundred one patients operated on to repair a rAAA within the last 10 years were included. The GAS and Hardman index were calculated for each patient separately. The relation between in-hospital mortality and the Hardman index and GAS was analyzed by means of the receiver-operator characteristic (ROC) curve. Univariate and multivariate methods of analyses were used to determine preoperative risk factors. Average age was 69 ± 8, and in-hospital mortality rate was 51.5%. Analysis of the ROC curve showed that the Hardman index had an area under the curve (AUC) = 0.71 (95% confidence interval [CI], 0.593-0.800, P = 0.0002) for predicting in-hospital mortality. The GAS had an AUC = 0.77 (95% CI, 0.680-0.851, P < 0.0001). The results of multivariate analysis revealed the presence of the following preoperative risk factors: age more than 63 years (odds ratio [OR], 4.4; 95% CI, 1.17-16.49, P = 0.028); loss of consciousness (OR, 9.33; 95% CI, 1.94-44.86, P = 0.005); creatinine higher than 1.7 mg/dL (OR, 5.52; 95% CI, 1.92-15.85, P = 0.001); and pH lower than 7.31 (OR, 3.77; 95% CI, 1.18-11.99, P = 0.024). In conclusion, the Hardman index and GAS have a significant correlation with in-hospital mortality rates. Nevertheless, a high score does not necessarily correspond with a definite mortality. This is why scoring systems could not be considered as the sole criterion for choosing patients for this study. Clinical experience was still the leading factor in deciding against or in favor of surgery.
authors.affiliation: Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Kurc
authors.forename: Soner
authors.initials: S
authors.lastname: Sanioglu
authors.forename: Ayca
authors.initials: A
authors.lastname: Ozgen
authors.forename: Serap Aykut
authors.initials: SA
authors.lastname: Aka
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yekeler
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000145:classification / Q000401:mortality* / Q000601:surgery; D019540:Area Under Curve; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D014474:Unconsciousness
chemical_list: D006454:Hemoglobins; D003404:Creatinine