在使用GRACE ACS得分来预测死亡率时,性别和种族的影响
Ikechukwu Ogbu1, Napatkamon Ayutyanont2, Sarah Wilson2
1MountainView Hospital, Las Vegas, NV.
HCA healthcare journal of medicine
|July 12, 2023
概括
全球急性冠状动脉事件注册 (GRACE) 评分有效预测急性冠状动脉综合征 (ACS) 患者的死亡率. 将性别和种族添加到GRACE评分中并没有显著提高其对死亡率的预测准确性.
科学领域:
- 心脏病学 心脏病学
- 临床风险分层的临床风险分层
- 公共卫生 公共卫生
背景情况:
- 急性冠状动脉综合征 (ACS) 构成了全球重大健康挑战,需要准确的早期风险分层.
- 全球急性冠状动脉事件注册表 (GRACE) 评分是ACS风险分层的验证工具.
- 目前的GRACE评分没有考虑种族和性别等人口因素.
研究的目的:
- 评估是否结合性别和种族可以提高GRACE得分对ACS患者结果的预测能力.
- 为了比较原始GRACE评分的表现与包括性别和种族在内的修改模型.
主要方法:
- 一项回顾性队列研究,涉及来自国家医疗保健系统的46764名ACS患者.
- 使用原始GRACE分数与包括性别和种族在内的修改GRACE分数进行预测准确度的比较.
- 通过接收机运行特征 (ROC) 曲线和曲线下面积 (AUC) 分析评估模型准确性.
主要成果:
- 原始GRACE得分显示,与修改模型 (AUC = 0.838) 相比,预测准确度略高 (AUC = 0.838),具有统计学上显著的差异 (P = .008).
- 尽管具有统计学意义,但观察到的AUC差异很小,并且鉴于样本大小,可能不具有临床意义.
- 虽然性别和种族最初与住院死亡率存在关联,但在多变量分析中,这些关系并不显著.
结论:
- 原来的GRACE评分仍然是预测ACS患者死亡率的有效和有效工具.
- 纳入性别和种族并没有显著改善GRACE评分的预测性能.
- 进一步的研究可能会探索其他人口或临床变量,以提高ACS的风险分层.
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