A Nomogram for Predicting In-Hospital Major Adverse Cardio- and Cerebro-Vascular Events in Patients Undergoing Major Noncardiac Surgery: A Large-Scale Nested Case-Control Study

Figures & data

Table 1 The Characteristics of Recruited Cases

Characteristics	Controls (n = 481)	MACCEs Group (n = 105)	p value
Sex (Men)	245 (51)	59 (56)	0.385
Age (years)	66 (56–79)	76 (65–84)	< 0.001
HLP	145 (30)	29 (28)	0.692
Diabetes	132 (27)	28 (27)	0.967
Insulin treatment	49 (10)	8 (8)	0.533
HBP	232 (48)	64 (61)	0.024
Stroke	67 (14)	23 (22)	0.057
CHF	6 (1)	16 (15)	< 0.001
AF	23 (5)	23 (22)	< 0.001
Ischemic heart disease	79 (16)	33 (31)	< 0.001
Dialysis	1 (0)	7 (7)	< 0.001
Chronic respiratory disease	29 (6)	13 (12)	0.038
VHD	11 (2)	17 (16)	< 0.001
Disseminated Cancer	22 (5)	7 (7)	0.517
Current smoker within 1 year	112 (23)	26 (25)	0.844
High-risk type of surgery	194 (40)	49 (47)	0.278
General anesthesia	311 (65)	72 (69)	0.515
PLT	210 (168–258)	208 (163–267)	0.629
Neutrophil count	4.17 (3.14–5.9)	4.95 (3.48–6.98)	0.007
Lymphocyte count	1.5 (1.07–1.96)	1.2 (0.86–1.75)	< 0.001
N/L%	2.68 (1.75–4.71)	3.72 (2.58–7.46)	< 0.001
Cr > 2.0 mg/dL	8 (2)	11 (10)	< 0.001
ST-T changes on ECG	109 (23)	40 (38)	< 0.001
Surgery type
Intraperitoneal surgery	227	50
Thoracic surgery	38	8
Peripheral arterioplasty	30	6
major orthopedic surgery (hip joints or spine)	182	37
Major urological surgery	4	4
ASA Class
1	52 (11)	3 (3)	< 0.001
2	330 (69)	48 (46)	< 0.001
3	94 (20)	47 (45)	< 0.001
4	5 (1)	7 (7)	< 0.001
The modified RCRI score
0	183 (38)	19 (18)
1	220 (46)	51 (49)
2	56 (12)	22 (21)
3	19 (4)	9 (9)
4	1 (0)	3 (3)
5	2 (0)	0 (0)
6	0 (0)	1 (1)

Notes: Data present as median (interquartile range) for continuous variables or n (%) for counting data. High-risk type of surgery included intraperitoneal, intrathoracic or suprainguinal vascular procedures according to the modified RCRI score.

Abbreviations: HLP, hyperlipidemia; HBP, high blood pressure; CHF, chronic heart failure; AF, atrial fibrillation; VHD, valvular heart disease; PLT, platelets; N/L%, neutrophil to lymphocyte ratio; Cr > 2.0mg/dL, preoperative serum creatinine > 2.0 mg/dL; ECG, electrocardiogram; RCRI, the modified Revised Cardiac Risk Index.

Table 2 The End-Point Events of Recruited Cases

MACCEs	Controls (n = 481)	MACCEs Group (n = 105)
AMI	0	19(18)
HF	0	56(53)
Death	0	26(25)
Stroke	0	18(17)

Note: Data present as n (%) for counting data.

Abbreviations: MACCEs, major adverse cardiovascular and cerebrovascular events; AMI, acute myocardial infarction; HF, heart failure.

Figure 1 Selected variables and the constructed nomogram. (A) Importance of each variable as measured by partial Wald χ² minus the predictor degrees of freedom. (B) Nomogram for the prediction model. CHF, chronic heart failure; VHD, valvular heart disease; Cr 2.0 > mg/dL, preoperative serum creatinine > 2.0 mg/dL.

Figure 2 Comparison between the new prediction nomogram and the modified RCRI score. (A) AUC of the new prediction nomogram (0.758) and the modified RCRI score (0.639). (B) Calibration plot of the new prediction nomogram. (C) Decision curve analysis evaluation of the two models. (D)The ROC curves of the new prediction nomogram in comparison with modified RCRI score in subgroup patients excluded cerebrovascular diseases or non-cardiac death.