心脏手术后中度至重度急性损伤的经手术后实验室测试预测模型的预测准确性
Sevag Demirjian1, C Allen Bashour2, Andrew Shaw2
1Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio.
JAMA
|March 8, 2022
概括
使用基本代谢面板实验室值的新预测模型可以准确识别心脏手术后急性损伤 (AKI) 风险的患者. 这种工具有助于及时诊断和启动AKI的潜在治疗.
科学领域:
- 肝脏病学
- 心脏病学
- 医疗信息学
背景情况:
- 及时诊断急性损伤 (AKI) 对于有效治疗至关重要,但血清肌素水平的增加往往落后于损伤.
- 这种延迟可能会阻碍AKI患者迅速开始必要的治疗.
研究的目的:
- 在接受心脏手术的患者中开发和验证AKI的预测模型.
- 评估这些模型在手术后72小时和14天内预测AKI的准确性.
主要方法:
- 用心脏手术的成人观察队列用于模型导出 (n=58,526).
- 模型在3家美国社区医院的外部队列中得到验证 (n=4,734).
- 预测变量包括手术前血清肌和手术后血清尿素,,碳酸盐和白的变化.
主要成果:
- 在72小时和14天内,该模型对中度至严重的AKI (AUC范围为0. 854至0. 876) 和需要透析的AKI (AUC范围为0. 900至0. 916) 进行了优异的预测.
- 在外部队列中的验证证实了良好的预测准确性,中度至严重的AKI的AUC为0. 860 (72小时) 和0. 842 (14天),需要透析的AKI为0. 879 (72小时) 和0. 873 (14天).
- 在导出和验证队列中,模型校准是充足的.
结论:
- 使用外科手术期间基本代谢面板实验室值的预测模型显示心脏手术后AKI的预测准确度很高.
- 这种模型可以帮助早期识别患有 AKI 风险的患者,从而改善临床结果.
- 需要进一步的研究来评估这种风险预测工具的临床效用.
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