Show simple item record

dc.contributor.authorStubbs, Daniel J.
dc.contributor.authorGrimes, Lisa A.
dc.contributor.authorErcole, Ari
dc.date.accessioned2020-02-04T04:14:20Z
dc.date.available2020-02-04T04:14:20Z
dc.date.issued2020-02-03
dc.date.submitted2019-09-04
dc.identifier.otherpone-d-19-24934
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/301703
dc.descriptionFunder: Wellcome Trust; funder-id: http://dx.doi.org/10.13039/100010269; Grant(s): Clinician PhD Fellowship paid from [Overarching grant: 486 204017/Z/16/Z
dc.description.abstractIntroduction: Cardiopulmonary exercise testing (CPET) is widely used within the United Kingdom for preoperative risk stratification. Despite this, CPET’s performance in predicting adverse events has not been systematically evaluated within the framework of classifier performance. Methods: After prospective registration on PROSPERO (CRD42018095508) we systematically identified studies where CPET was used to aid in the prognostication of mortality, cardiorespiratory complications, and unplanned intensive care unit (ICU) admission in individuals undergoing non-cardiopulmonary surgery. For all included studies we extracted or calculated measures of predictive performance whilst identifying and critiquing predictive models encompassing CPET derived variables. Results: We identified 36 studies for qualitative review, from 27 of which measures of classifier performance could be calculated. We found studies to be highly heterogeneous in methodology and quality with high potential for bias and confounding. We found seven studies that presented risk prediction models for outcomes of interest. Of these, only four studies outlined a clear process of model development; assessment of discrimination and calibration were performed in only two and only one study undertook internal validation. No scores were externally validated. Systematically identified and calculated measures of test performance for CPET demonstrated mixed performance. Data was most complete for anaerobic threshold (AT) based predictions: calculated sensitivities ranged from 20-100% when used for predicting risk of mortality with high negative predictive values (96-100%). In contrast, positive predictive value (PPV) was poor (2.9-42.1%). PPV appeared to be generally higher for cardiorespiratory complications, with similar sensitivities. Similar patterns were seen for the association of Peak VO2 (sensitivity 85.7-100%, PPV 2.7-5.9%) and VE/VCO2 (Sensitivity 27.8%-100%, PPV 3.4-7.1%) with mortality. Conclusions: In general CPET’s ‘rule-out’ capability appears better than its ability to ‘rule-in’ complications. Poor PPV may reflect the frequency of complications in studied populations. Our calculated estimates of classifier performance suggest the need for a balanced interpretation of the pros and cons of CPET guided pre-operative risk stratification.
dc.languageen
dc.publisherPublic Library of Science
dc.rightsAttribution 4.0 International (CC BY 4.0)en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectResearch Article
dc.subjectMedicine and health sciences
dc.subjectResearch and analysis methods
dc.subjectBiology and life sciences
dc.subjectPhysical sciences
dc.titlePerformance of cardiopulmonary exercise testing for the prediction of post-operative complications in non cardiopulmonary surgery: A systematic review
dc.typeArticle
dc.date.updated2020-02-04T04:14:20Z
prism.publicationNamePLOS ONE, volume 15, issue 2
dc.identifier.doi10.17863/CAM.48774
dcterms.dateAccepted2019-11-24
rioxxterms.versionofrecord10.1371/journal.pone.0226480
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
datacite.contributor.supervisoreditor: Kovacs, Gabor
dc.contributor.orcidStubbs, Daniel J. [0000-0003-2778-5226]
dc.contributor.orcidErcole, Ari [0000-0001-8350-8093]
dc.identifier.eissn1932-6203


Files in this item

Thumbnail
Thumbnail
Thumbnail
Thumbnail
Thumbnail
Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record

Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's licence is described as Attribution 4.0 International (CC BY 4.0)