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八个破裂的腹腔大动脉动脉瘤死亡率预测模型的外部验证表明预测准确性有限
Shimena R Li1, Muhammad S Mazroua2, Katherine M Reitz3
1Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist Medical Centre, Winston-Salem, NC, USA.
概括
现有的腹部大动脉动脉瘤破裂 (rAAA) 风险模型在预测死亡率方面显示出有限的准确性. 外部验证显示了公平的歧视和校准,表明这些工具的谨慎临床应用.
科学领域:
- 血管外科 血管外科
- 医疗信息学 医疗信息学
- 健康 结果 研究 研究 结果
背景情况:
- 对于破裂腹腔大动脉动脉瘤 (rAAA) 死亡率存在许多风险预测模型.
- 这些模型往往缺乏外部验证,这限制了它们在现实世界中的适用性.
研究的目的:
- 对八种常见的rAAA死亡风险预测模型的准确性进行外部验证和比较.
- 在一个大规模的当代群体中评估模型性能.
主要方法:
- 在一个多中心医疗保健系统 (2010-2020年) 中对315次rAAA维修进行了回顾性分析.
- 对八种模型的评估 (包括更新的格拉斯哥动脉瘤评分,温哥华评分系统) 进行30天死亡率预测.
- 对歧视 (AUC) 的评估,校准 (Hosmer-Lemeshow,Brier分数) 和临床实用性 (决策曲线分析).
主要成果:
- 30天的死亡率为32.1%.
- 三种模型表明公平歧视 (AUC ≥0.70),更新的格拉斯哥动脉瘤得分 (GAS) 达到最高的AUC (0.74).
- 所有模型的校准都不够好;与预期死亡相比,意外幸存者在手术前的休克和凝血病较少.
结论:
- 目前的rAAA风险预测模型只提供公平的歧视和可变校准.
- 现有的模型可能无法完全捕捉影响rAAA死亡率的关键生理因素.
- 这些风险预测工具的临床使用应谨慎使用.
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