导出和验证心脏手术后替代疗法的简化预测指数
Duminda N Wijeysundera1, Keyvan Karkouti, Jean-Yves Dupuis
1Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. duminda.wijeysundera@uhn.on.ca
JAMA
|April 26, 2007
概括
使用手术前数据的新预测指数准确地识别了心脏手术后需要置换疗法 (RRT) 的患者. 该工具有助于分层风险,改善临床决策和用于RRT预测的研究.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 预测心脏手术后需要置换疗法 (RRT) 对患者管理和研究至关重要.
- 现有的方法可能无法在手术前充分识别有风险的个体.
研究的目的:
- 开发和验证术后RRT的预测指数,使用随时可用的术前信息.
- 改善与心脏手术后RRT相关的临床决策和研究设计.
主要方法:
- 在加拿大安大略省两家医院对20131名心脏手术患者进行了回顾性队列研究.
- 使用了开发队列 (n=10,751) 和两个验证队列 (n=2,566和n=6,814).
- 确定了关键的手术前预测因素,包括估计的膜过率,糖尿病,喷射分数和手术紧急情况.
主要成果:
- 预测指数,得分为0-8分,确定了RRT的显著预测因素.
- 低风险患者 (得分≤1) 的RRT率为0.4%,而高风险患者 (得分≥4) 的RRT率为10%.
- 该指数表现出良好的区分能力,ROC曲线下的面积在整个队列中从0.78到0.81不等.
结论:
- 随时可用的手术前信息可以有效地预测心脏手术后需要RRT的需要.
- 一个简单的预测指数准确地区分低风险和高风险患者.
- 开发的指数显示出良好的概括性,并改善了RRT概率率预测.
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