开发一种风险评分系统,用于预测出产期间住院期间输血的风险
Ann M Bruno1, Grecio J Sandoval1, Brenna L Hughes1
1University of Utah Health Sciences Center, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
一个新的风险评分预测了分娩期间住院期间输血. 关键预测因素包括血小板缺血和胎盘断裂,有助于产科患者的临床决策.
科学领域:
- 产科和妇科 产科和妇科
- 输血医学 输血医学
- 医疗信息学 医疗信息学
背景情况:
- 在分娩期间输血是产科护理的一个重要问题.
- 需要预测工具来识别高风险患者,以便及时干预.
- 怀孕期间输血的现有风险分层方法可能缺乏精度.
研究的目的:
- 开发和内部验证一个实用的,数据驱动的风险评分系统.
- 预测在住院分娩期间输血的可能性.
- 为当代美国产科患者创建一个工具.
主要方法:
- 2019-2020年间分娩的多中心队列 (n=21,780) 患者的二次分析.
- 排除患有胎盘增殖谱的患者.
- 开发一个多变量逻辑回归模型,使用k-fold交叉验证和逐步倒退消除进行内部验证.
主要成果:
- 2.5%的患者接受了输血.
- 发现的最高风险因素:血小板缺血,胎盘断裂或产前出血.
- 风险得分从0到17不等,预测输血风险从1.0%到84.4%.
- 预测接收器操作曲线 (AUC) 下的面积为0.81.1.
结论:
- 开发了一种临床适用的数值风险评分,以预测分娩期间住院期间的输血.
- 风险评分系统在验证子样本中表现出良好的预测性能.
- 建议对这种风险评分系统进行外部验证,以获得更广泛的临床应用.
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