緊急心不全の将来的な検証 急性心不全の死亡リスクグレード
Douglas S Lee1,2,3, Jacques S Lee3,4, Michael J Schull1,3,4
1ICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Circulation
|December 28, 2018
まとめ
急性心不全の死亡リスクグレード (EHMRG) モデルは,急性心不全の患者の7日および30日間の死亡率を正確に予測します. これらの検証されたツールは,医師の見積もりを改善し,緊急治療室でのより良い臨床的意思決定を可能にします.
科学分野:
- 心臓病科
- 緊急 医療
- 臨床リスクの予測
背景:
- 急性心不全 (AHF) の管理には,緊急治療室での正確なリスク分層が必要です.
- 早期出院に対する医師の決定は,信頼性の高い死亡リスク評価に依存します.
- 死亡率の予測のために,Emergency Heart Failure Mortality Grade (EHMRG7とEHMRG30-ST) のモデルが以前開発されました.
研究 の 目的:
- 7日間の死亡率 (EHMRG7) の緊急心不全死亡リスクグレードを将来的に検証する.
- 30日間の死亡率 (EHMRG30-ST) の緊急心不全死亡リスクグレードを検証する.
- EHMRGモデルの予測性能と医師の推定リスクを比較する.
主な方法:
- 9つの病院で1983人のAHF患者を対象とした多センターの前向きな検証試験です.
- 7日間の死亡リスク (PER7) を推定した医師は,モデル予測の知識がなかった.
- EHMRG7とEHMRG30-STのモデルの差別と再分類の純改善はPER7に対して評価された.
主要な成果:
- EHMRG7は,医師の推定値 (c- 統計値: 0. 71; P=0. 022) と比較して,7日間の死亡率 (c- 統計値: 0. 81) を優れていることを示した.
- EHMRG30- STは30日間の死亡率について良好な差別を示した (c統計値0. 77).
- EHMRG7では,医師の推定値よりも,有意な純再分類の改善が観察されました.
結論:
- 検証されたEHMRGモデルは,急性心不全における7日および30日間の死亡率を正確に予測します.
- これらのモデルは,医師の推定値と比べてリスクの階層化が改善されています.
- EHMRGモデルは,緊急治療室の医師が 患者の処置に関する情報に基づいた決定を下すのに役立ちます.
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