The recent study of Drs. Melendez and Carlon1–
demonstrated that an increased cardiopulmonary risk index (CPRI) score
was predictive of cardiopulmonary complications associated with
pneumonectomy (positive predictive value [PPV] 1.0, negative
predictive value [NPV] 0.64). In contrast to our Veterans
Administration studies,2,,3 these investigators found an
increased CPRI not predictive for other thoracic procedures. Important
differences in patient populations, technique of scoring, methods for
determining complications and preoperative and postoperative treatment
(of CPRI risk factors) may explain part of the discrepancy. Although
interpretation should be cautious given their preliminary nature, there
are now four additional prospective studies (including my
own4) totaling 350 patients, that have examined the
issue.4,,5,,6,,7 Two blinded trials in non-Veterans
Administration populations4,,5 found a CPRI ≥ 4
predictive but with less accuracy than our initial experience with PPV
(0.62 to 0.64) and NPV (0.77 to 0.83). This may result from reduced
predictive accuracy in female patients (PPV 0.42, NPV
0.79)4 or among those undergoing non-lung-cancer surgery.
Importantly, approximately 50% of the patients reported by Drs.
Melendez and Carlon were women.