Matches in SemOpenAlex for { <https://semopenalex.org/work/W4200417445> ?p ?o ?g. }
- W4200417445 abstract "The Revised Cardiac Risk Index (RCRI) is a widely acknowledged prognostic model to estimate preoperatively the probability of developing in-hospital major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the RCRI does not always make accurate predictions, so various studies have investigated whether biomarkers added to or compared with the RCRI could improve this.Primary: To investigate the added predictive value of biomarkers to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Secondary: To investigate the prognostic value of biomarkers compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Tertiary: To investigate the prognostic value of other prediction models compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery.We searched MEDLINE and Embase from 1 January 1999 (the year that the RCRI was published) until 25 June 2020. We also searched ISI Web of Science and SCOPUS for articles referring to the original RCRI development study in that period.We included studies among adults who underwent noncardiac surgery, reporting on (external) validation of the RCRI and: - the addition of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of the RCRI to other models. Besides MACE, all other adverse outcomes were considered for inclusion.We developed a data extraction form based on the CHARMS checklist. Independent pairs of authors screened references, extracted data and assessed risk of bias and concerns regarding applicability according to PROBAST. For biomarkers and prediction models that were added or compared to the RCRI in ≥ 3 different articles, we described study characteristics and findings in further detail. We did not apply GRADE as no guidance is available for prognostic model reviews.We screened 3960 records and included 107 articles. Over all objectives we rated risk of bias as high in ≥ 1 domain in 90% of included studies, particularly in the analysis domain. Statistical pooling or meta-analysis of reported results was impossible due to heterogeneity in various aspects: outcomes used, scale by which the biomarker was added/compared to the RCRI, prediction horizons and studied populations. Added predictive value of biomarkers to the RCRI Fifty-one studies reported on the added value of biomarkers to the RCRI. Sixty-nine different predictors were identified derived from blood (29%), imaging (33%) or other sources (38%). Addition of NT-proBNP, troponin or their combination improved the RCRI for predicting MACE (median delta c-statistics: 0.08, 0.14 and 0.12 for NT-proBNP, troponin and their combination, respectively). The median total net reclassification index (NRI) was 0.16 and 0.74 after addition of troponin and NT-proBNP to the RCRI, respectively. Calibration was not reported. To predict myocardial infarction, the median delta c-statistic when NT-proBNP was added to the RCRI was 0.09, and 0.06 for prediction of all-cause mortality and MACE combined. For BNP and copeptin, data were not sufficient to provide results on their added predictive performance, for any of the outcomes. Comparison of the predictive value of biomarkers to the RCRI Fifty-one studies assessed the predictive performance of biomarkers alone compared to the RCRI. We identified 60 unique predictors derived from blood (38%), imaging (30%) or other sources, such as the American Society of Anesthesiologists (ASA) classification (32%). Predictions were similar between the ASA classification and the RCRI for all studied outcomes. In studies different from those identified in objective 1, the median delta c-statistic was 0.15 and 0.12 in favour of BNP and NT-proBNP alone, respectively, when compared to the RCRI, for the prediction of MACE. For C-reactive protein, the predictive performance was similar to the RCRI. For other biomarkers and outcomes, data were insufficient to provide summary results. One study reported on calibration and none on reclassification. Comparison of the predictive value of other prognostic models to the RCRI Fifty-two articles compared the predictive ability of the RCRI to other prognostic models. Of these, 42% developed a new prediction model, 22% updated the RCRI, or another prediction model, and 37% validated an existing prediction model. None of the other prediction models showed better performance in predicting MACE than the RCRI. To predict myocardial infarction and cardiac arrest, ACS-NSQIP-MICA had a higher median delta c-statistic of 0.11 compared to the RCRI. To predict all-cause mortality, the median delta c-statistic was 0.15 higher in favour of ACS-NSQIP-SRS compared to the RCRI. Predictive performance was not better for CHADS2, CHA2DS2-VASc, R2CHADS2, Goldman index, Detsky index or VSG-CRI compared to the RCRI for any of the outcomes. Calibration and reclassification were reported in only one and three studies, respectively.Studies included in this review suggest that the predictive performance of the RCRI in predicting MACE is improved when NT-proBNP, troponin or their combination are added. Other studies indicate that BNP and NT-proBNP, when used in isolation, may even have a higher discriminative performance than the RCRI. There was insufficient evidence of a difference between the predictive accuracy of the RCRI and other prediction models in predicting MACE. However, ACS-NSQIP-MICA and ACS-NSQIP-SRS outperformed the RCRI in predicting myocardial infarction and cardiac arrest combined, and all-cause mortality, respectively. Nevertheless, the results cannot be interpreted as conclusive due to high risks of bias in a majority of papers, and pooling was impossible due to heterogeneity in outcomes, prediction horizons, biomarkers and studied populations. Future research on the added prognostic value of biomarkers to existing prediction models should focus on biomarkers with good predictive accuracy in other settings (e.g. diagnosis of myocardial infarction) and identification of biomarkers from omics data. They should be compared to novel biomarkers with so far insufficient evidence compared to established ones, including NT-proBNP or troponins. Adherence to recent guidance for prediction model studies (e.g. TRIPOD; PROBAST) and use of standardised outcome definitions in primary studies is highly recommended to facilitate systematic review and meta-analyses in the future." @default.
- W4200417445 created "2021-12-31" @default.
- W4200417445 creator A5015723615 @default.
- W4200417445 creator A5018993075 @default.
- W4200417445 creator A5029927490 @default.
- W4200417445 creator A5065571198 @default.
- W4200417445 creator A5071965605 @default.
- W4200417445 creator A5083104697 @default.
- W4200417445 date "2021-12-21" @default.
- W4200417445 modified "2023-10-04" @default.
- W4200417445 title "The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery" @default.
- W4200417445 cites W140188979 @default.
- W4200417445 cites W1493047627 @default.
- W4200417445 cites W1500903888 @default.
- W4200417445 cites W1532263517 @default.
- W4200417445 cites W154795497 @default.
- W4200417445 cites W1551793406 @default.
- W4200417445 cites W1581514961 @default.
- W4200417445 cites W1587614986 @default.
- W4200417445 cites W1606835721 @default.
- W4200417445 cites W1610750314 @default.
- W4200417445 cites W1625609137 @default.
- W4200417445 cites W1625775413 @default.
- W4200417445 cites W1673665560 @default.
- W4200417445 cites W1680159908 @default.
- W4200417445 cites W1687620054 @default.
- W4200417445 cites W1708002708 @default.
- W4200417445 cites W1773722281 @default.
- W4200417445 cites W1786002196 @default.
- W4200417445 cites W1812168438 @default.
- W4200417445 cites W1887988070 @default.
- W4200417445 cites W1919245337 @default.
- W4200417445 cites W1926317881 @default.
- W4200417445 cites W1928415008 @default.
- W4200417445 cites W1950893026 @default.
- W4200417445 cites W1953039658 @default.
- W4200417445 cites W1962640481 @default.
- W4200417445 cites W1964366771 @default.
- W4200417445 cites W1965178778 @default.
- W4200417445 cites W1970297586 @default.
- W4200417445 cites W1972306763 @default.
- W4200417445 cites W1972697619 @default.
- W4200417445 cites W1973763955 @default.
- W4200417445 cites W1973914781 @default.
- W4200417445 cites W197506885 @default.
- W4200417445 cites W1975969435 @default.
- W4200417445 cites W1976099061 @default.
- W4200417445 cites W1976763651 @default.
- W4200417445 cites W1976893141 @default.
- W4200417445 cites W1977916382 @default.
- W4200417445 cites W1979407189 @default.
- W4200417445 cites W1981684263 @default.
- W4200417445 cites W1981903254 @default.
- W4200417445 cites W1987094650 @default.
- W4200417445 cites W1987114122 @default.
- W4200417445 cites W1987145024 @default.
- W4200417445 cites W1987592798 @default.
- W4200417445 cites W1989694875 @default.
- W4200417445 cites W1990172132 @default.
- W4200417445 cites W1992212357 @default.
- W4200417445 cites W1993230630 @default.
- W4200417445 cites W1993784573 @default.
- W4200417445 cites W1994682257 @default.
- W4200417445 cites W1994779983 @default.
- W4200417445 cites W1995076226 @default.
- W4200417445 cites W1995526450 @default.
- W4200417445 cites W1995925352 @default.
- W4200417445 cites W1996890272 @default.
- W4200417445 cites W1997807481 @default.
- W4200417445 cites W1998392635 @default.
- W4200417445 cites W1998782011 @default.
- W4200417445 cites W2001312671 @default.
- W4200417445 cites W2002593320 @default.
- W4200417445 cites W2002989368 @default.
- W4200417445 cites W2003095103 @default.
- W4200417445 cites W2003187815 @default.
- W4200417445 cites W2005721408 @default.
- W4200417445 cites W2008185602 @default.
- W4200417445 cites W2008293401 @default.
- W4200417445 cites W2008793631 @default.
- W4200417445 cites W2009753781 @default.
- W4200417445 cites W2012560274 @default.
- W4200417445 cites W2012826488 @default.
- W4200417445 cites W2012833167 @default.
- W4200417445 cites W2013003219 @default.
- W4200417445 cites W2013253141 @default.
- W4200417445 cites W2013703670 @default.
- W4200417445 cites W2015211996 @default.
- W4200417445 cites W2015413151 @default.
- W4200417445 cites W2015644587 @default.
- W4200417445 cites W2015886360 @default.
- W4200417445 cites W2016028626 @default.
- W4200417445 cites W2016460005 @default.
- W4200417445 cites W2018249142 @default.
- W4200417445 cites W2018418197 @default.
- W4200417445 cites W2019168887 @default.
- W4200417445 cites W2019982728 @default.
- W4200417445 cites W2020353535 @default.
- W4200417445 cites W2020467721 @default.
- W4200417445 cites W2020683868 @default.