张楠, 林清婷, 朱华栋. 心脏骤停患者院内死亡预测模型的构建[J]. 协和医学杂志, 2023, 14(5): 1023-1030. DOI: 10.12290/xhyxzz.2023-0378
引用本文: 张楠, 林清婷, 朱华栋. 心脏骤停患者院内死亡预测模型的构建[J]. 协和医学杂志, 2023, 14(5): 1023-1030. DOI: 10.12290/xhyxzz.2023-0378
ZHANG Nan, LIN Qingting, ZHU Huadong. Prediction Model for In-hospital Death of Patients with Cardiac Arrest[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1023-1030. DOI: 10.12290/xhyxzz.2023-0378
Citation: ZHANG Nan, LIN Qingting, ZHU Huadong. Prediction Model for In-hospital Death of Patients with Cardiac Arrest[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1023-1030. DOI: 10.12290/xhyxzz.2023-0378

心脏骤停患者院内死亡预测模型的构建

Prediction Model for In-hospital Death of Patients with Cardiac Arrest

  • 摘要:
      目的  构建心脏骤停患者院内死亡的预测模型。
      方法  本研究为回顾性分析,纳入美国重症监护医学信息数据库Ⅳ(medical information mart for intensive care-Ⅳ,MIMIC-Ⅳ)2.0中出院诊断包含心脏骤停且具有ICU入住经历的18岁以上成年患者。研究采用逐步回归筛选变量,选取逐步回归分析结果中P<0.05的变量并纳入多因素Logistic回归,以构建心脏骤停患者院内死亡的预测模型。绘制受试者操作特征(receiver operator characteristic,ROC)曲线及校准曲线,分别对预测模型的区分度和一致性进行评价,并创建评估心脏骤停患者死亡风险的动态诺模图计算器。
      结果  共纳入1772例符合入选标准的患者,平均年龄为(64.93±16.52)岁,其中963例(54.3%, 963/1772)患者发生院内死亡。多因素Logistic回归构建心脏骤停患者院内死亡风险预测模型的指标包括:心脏骤停病因诊断、经年龄调整后的查尔森合并症指数(Chalson comorbidity index,CCI)评分、体质量指数、ICU入住24 h内的生命体征、ICU入住24 h内的乳酸水平最低值、ICU入住24 h内的格拉斯哥昏迷评分最低值、超声心动图检查、有创机械通气和血管升压素的使用。该模型的灵敏度和特异度分别为73.1%(95% CI:0.702~0.759)和71.6%(95% CI:0.683~0.745),ROC曲线下面积为0.806(95% CI:0.786~0.826)。
      结论  基于本研究建立的预测模型可能有助于预测心脏骤停患者的院内死亡。

     

    Abstract:
      Objective  To build a prediction model of the in-hospital death of patients with cardiac arrest.
      Methods  This study is a retrospective analysis based on the medical information mart for intensive care-Ⅳ (MIMIC-Ⅳ)2.0. We gathered the information of patients above 18 years old, with cardiac arrest and intensive care unit (ICU) experience. A stepwise multi-variate logistic regression analysis was performed to filter variables, variables with P values < 0.05 were kept and enter as predictors of in-hospital death of patients with cardiac arrest. The model was evaluated with receiver operating characteristic (ROC) curve for discriminative power and with calibration curve for consistency. Finally, an online dynamic nomogram calculator was built to calculate the risk of in-hospital death.
      Results  This study included 1772 patients with cardiac arrest. The mean age of those patients was (64.93±16.52) years old, and 963 (54.3%) patients suffered in-hospital death. The factors of the prediction model for in-hospital death of cardiac arrest patients constructed based on multi-variate logistic regression included: potential cardiac disease diagnosis, age adjusted Chalson comorbidity index(CCI), body mass index (BMI), vital signs, lowest lactic acid and lowest Glasgow coma scale (GCS) during the first 24 hours after entering ICU, cardiac ultrasound examination, invasive mechanical ventilation and vasopressin utilization. The sensitivity and specificity of the prediction model were 73.1%(95% CI: 0.702-0.759) and 71.6%(95% CI: 0.683-0.745), respectively. Area under the ROC curve was 0.806(95% CI: 0.786-0.826).
      Conclusions  The prediction model built in this study can properly predict the in-hospital death of patients with cardiac arrest.

     

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