预测患有慢性阻塞性肺病的患者长期停留在重症监护室的风险名录
Hongtao Cheng1, Jieyao Li2, Fangxin Wei1
1School of Nursing, Jinan University, Guangzhou, China.
这项研究开发了名图,以预测慢性阻塞性肺病 (COPD) 患者的长期集中治疗室 (ICU) 停留时间. 这些工具使用11个易于收集的因素来帮助临床决策,并减少患者的负担.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 重症监护室 (ICU) 的住宿费用越来越高.
- 慢性阻塞性肺病 (COPD) 患者的长期ICU停留时间 (LOS) 是一个重大挑战.
- 为长期的ICU LOS开发预测工具对于资源管理和患者护理至关重要.
研究的目的:
- 构建和验证一个风险列线图 (nomogram).
- 预测慢性阻塞性肺病 (COPD) 患者在重症监护室 (ICU) 的长时间停留 (LOS).
- 确定COPD患者长时间在ICU停留的关键预测因素.
主要方法:
- 4940名COPD患者的数据集被随机划分为培训 (70%) 和验证 (30%) 集.
- 最小绝对收缩和选择运算符 (LASSO) 回归用于变量选择.
- 多因素后勤回归构建了预测模型,并通过ROC曲线,霍斯默-莱梅斯测试和决策曲线分析 (DCA) 进行了验证.
主要成果:
- 确定了11种预测因素:败血症,置换疗法,脑血管疾病,呼吸衰竭,呼吸器相关的肺炎,上腺素,支气管扩展剂,侵入性机械通风,电解质障碍,格拉斯哥昏迷量表得分和体温.
- 诺姆图表显示出良好的预测能力,AUC为0.826 (训练) 和0.827 (验证).
- 预测和观察概率之间的强烈一致性得到了Hosmer-Lemeshow测试的证实,DCA表明了良好的临床有效性.
结论:
- 预测COPD患者长期住院ICU的原始和动态诺姆图成功构建和验证.
- 诺姆图利用了11个易于收集的参数,提供了实际的临床实用性.
- 这些工具可以指导医疗和护理从业者,潜在地减少疾病和患者的经济负担.
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