一项回顾性队列研究,评估将生物标志物添加到脆弱性风险分析指数中
Jamie L Estock1, Prakash K Pandalai2, Jason M Johanning3
1Center for Health Equity Research and Promotion, VA Pittsburg Healthcare System, University Drive C, Pittsburgh, Pennsylvania.
The Journal of surgical research
|August 24, 2023
概括
在风险分析指数 (RAI) 中添加血红素和白蛋白等生物标志物略有改善了对非常脆弱患者180天死亡率的预测. 然而,这种增强为一般脆弱查工具提供了有限的临床实用性.
科学领域:
- 手术成果研究的研究结果.
- 老年医学 老年医学
- 生物标志物的分析分析.
背景情况:
- 风险分析指数 (RAI) 是一个主观的脆弱性评估工具,与不良的术后结果相关.
- 关于RAI缺乏客观的,基于生物标志物的组件,存在批评.
研究的目的:
- 评估将常见生物标志物纳入RAI以预测术后死亡率的好处.
- 评估生物标志物对RAI预测准确性的影响.
主要方法:
- 使用退伍军人事务外科质量改善计划 (VASQIP) 数据库进行回顾性队列研究.
- 为了预测180天后的术后死亡率,分析了RAI,体重指数 (BMI),肌素,血红素和白蛋白.
- 进行了个体和复合变量分析.
主要成果:
- 在180天死亡率 (c=0.839) 中,RAI表现出强烈的歧视.
- 随着血红素 (c=0.862) 和白蛋白 (c=0.870) 的添加,差异显著改善.
- 改善主要观察到非常脆弱的患者 (RAI ≥49) 和高RAI值,其中模型倾向于过度预测死亡率.
结论:
- 虽然某些生物标志物增强了RAI对非常脆弱个体180天死亡率的预测能力,但临床效用有限.
- 由于受影响的小子组和潜在的过度预测,对脆弱选工具的歧视观察到的改善可能没有临床意义.
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