一个动态的诺伍德死亡率估计:描述诺伍德行动后的个体,更新,预测死亡率轨迹
James M Meza1, Eugene H Blackstone2,3, Madison B Argo4,5
1Division of Cardiothoracic and Thoracic Surgery, Duke University Medical Center, Durham, NC.
JTCVS open
|July 10, 2023
概括
诺伍德后死亡率是不可预测的,通常与阶段间事件有关,而不仅仅是初始因素. 这项研究引入了针对新生儿个性化精准医学的动态死亡率预测.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 生产性心脏手术 手术 生产心脏手术
- 关键护理医学 关键护理医学
背景情况:
- 在患有严重左心阻塞的新生儿中,诺伍德手术后的死亡率仍然很高和不可预测.
- 目前的死亡率预测模型没有充分纳入阶段间事件,这些事件对于患者的结果至关重要.
研究的目的:
- 确定与时间相关的间期事件和术前特征与诺伍德后死亡率的关联.
- 开发一个动态模型来预测诺伍德手术后的个体死亡轨迹.
主要方法:
- 利用来自先天性心脏外科医生协会关键左心阻塞队列 (360名新生儿,2005年至2016年) 的数据.
- 应用参数危险分析,包括基线,操作特征和与时间相关的不良事件,程序和生理测量 (体重,氧和).
- 导出并绘制个人预测的死亡率轨迹,这些轨迹随着时间的推移动态更新.
主要成果:
- 确定了死亡的关键风险因素,包括心脏骤停,心房膜吐,内出血/中风,败血症,较低的氧气和度,再入院,以及较小的基线大动脉/心心膜尺寸.
- 观察到每个患者预测的死亡率轨迹随着风险因素随着时间的推移而变化.
- 发现诺伍德后死亡率主要与时间相关的术后事件和措施有关,而不是仅仅与基线特征有关.
结论:
- 诺伍德后死亡风险是动态的,并受到术后事件和生理措施的显著影响.
- 动态的,个性化的死亡率预测轨迹为管理新生儿后诺伍德手术提供了向精准医学的范式转变.
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