急性呼吸窘迫综合征患者1年内死亡风险的预测诺模图:基于MIMIC-Ⅲ数据库回顾性研究  

Prediction nomogram of one-year mortality risk in patients with acute respiratory distress syndrome:a retrospective study based on MIMIC-Ⅲdatabase

作　　者：董小荣[1] 马莉[1] 马德胜 张蓓[1] DONG Xioo-rong;MA Li;MA De-sheng;ZHANG Bei(Department of Intersie Care Unit,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院重症医学科,甘肃兰州730030

出　　处：《中国实用内科杂志》2023年第9期755-759,774,共6页Chinese Journal of Practical Internal Medicine

基　　金：北京协和医学基金会睿E(睿意)急诊医学研究专项基金(R2018022)。

摘　　要：目的探讨急性呼吸窘迫综合征(ARDS)患者1年内死亡的危险因素,建立预测死亡风险的诺模图。方法回顾性分析美国重症监护医学信息数据库-Ⅲ(MIMIC-Ⅲ)中自2001年6月1日至2012年10月31日于美国麻萨诸塞州波士顿贝斯以色列女执事医疗中心重症监护室312例ARDS患者的数据,按2∶1比例随机分为训练组(208例)和验证组(104例),以1年内是否死亡为主要结局指标,用单因素和多因素Cox回归分析得出独立危险因素,绘制预测死亡风险的诺模图,通过受试者工作特征曲线下面积(AUC)、校正曲线评价诺模图的预测能力。结果训练组与验证组患者临床资料差异无统计学意义(P>0.05)。多因素Cox回归发现,年龄(HR 1.04,P<0.001)、呼吸频率(HR 1.08,P=0.003)、红细胞分布宽度(RDW)(HR 1.11,P=0.020)、简明急性生理功能评估系统Ⅱ(SAPSⅡ)评分(HR 1.03,P=0.002)是ARDS患者1年内死亡的独立危险因素;以此绘制诺模图,在训练组和验证组中,诺模图AUC为0.774和0.762,提示该模型具有良好的预测能能力;训练组和验证组校正曲线的一致性指数为0.802和0.754,提示校正曲线与标准曲线拟合度良好。结论年龄、呼吸频率、RDW、SAPSⅡ是ARDS患者1年内死亡的独立危险因素,其构建的诺模图对临床ARDS患者具有良好的预测价值。Objective To explore the risk factors of 1-year mortality in patients with acute respiratory distress syndrome(ARDS)and establish nomogram for predicting mortality risk.Methods The data of 312 ARDS patients from the MIMIC-Ⅲdatabase were extracted in the Intensive Care Unit of Beth Israel Deaconess Hospital from June 1,2001 to October 31,2012 was retrospectively analyzed.All patients were randomly divided into the training group(208 cases)and the validation group(104 cases)according to the ratio of 2∶1,and 1-year mortality was used as the primary outcome index.The independent risk factors were obtained by univariate and multivariate regression analysis,and the nomogram was drawn to predict mortality risk.The prediction ability of nomogram was evaluated by area under receiver operating characteristic curve(AUC)and calibration curve.Results There was no significant difference in baseline data between the training group and the validation group(P<0.05).Multivariate Cox regression found that age(HR 1.04,P<0.001),respiratory rate(HR 1.08,P=0.003),red blood cell distribution width(RDW)(HR 1.11,P=0.020)and simplified acute physiology scoreⅡ(SAPSⅡ)(HR 1.03,R=0.002)were independent risk factors of 1-year mortality in ARDS patients.In the training group and the validation group,the AUC of the nomograms was 0.774 and 0.762,indicating that the model had good predictive ability.The C-index of the calibration curve was 0.802 and 0.754,indicating that calibration curve had a good fitness with the standard curve.Conclusion Age,respiratory rate,RDW and SAPSⅡare independent risk factors for 1-year mortality in ARDS patients,and the nomogram constructed has good predictive value for clinical ARDS patients.

关 键 词：急性呼吸窘迫综合征 预后 诺模图 1年病死率 

分 类 号：R563.8[医药卫生—呼吸系统]