紧急心力衰竭的前景验证 急性心力衰竭的死亡风险等级
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
概括
紧急心力衰竭死亡风险等级 (EHMRG) 模型准确预测急性心力衰竭患者的7天和30天死亡率. 这些经过验证的工具改善了医生的估计,使得急诊室的临床决策更好.
科学领域:
- 心脏病学
- 紧急医疗
- 临床风险预测
背景情况:
- 急性心力衰竭 (AHF) 需要在急诊室进行准确的风险分层.
- 医生对入院或早出院的决定取决于可靠的死亡风险评估.
- 此前已开发出紧急心力衰竭死亡风险等级 (EHMRG7和EHMRG30-ST) 模型来预测死亡率.
研究的目的:
- 为了前性验证紧急心力衰竭死亡风险等级的7天死亡率 (EHMRG7).
- 为验证30天死亡率的紧急心力衰竭死亡风险等级 (EHMRG30-ST).
- 将EHMRG模型的预测性能与医生估计的风险进行比较.
主要方法:
- 一项多中心前性验证研究涉及9个医院的1983名AHF患者.
- 在模型预测知识之前,医生估计了7天死亡风险 (PER7).
- 根据PER7评估了EHMRG7和EHMRG30-ST模型的歧视和净重新分类改进.
主要成果:
- 与医生的估计 (c- 统计,0. 71; P=0. 022) 相比,EHMRG7在7天死亡率上表现出更好的区别.
- 对于30天死亡率,EHMRG30-ST显示出良好的区别 (c-统计,0. 77).
- 与医生的估计相比,EHMRG7观察到显著的净重新分类改善.
结论:
- 经过验证的EHMRG模型准确地预测了急性心力衰竭的7天和30天死亡率.
- 这些模型提供了与医生估计相比更好的风险分层.
- EHMRG模型可以帮助急诊室医生做出明智的患者处置决定.
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