基于logistic回归和ROC曲线构建左西孟旦致心律失常预测模型与评价  

Establishment and evaluation of a prediction model for levosimendan induced arrhythmia based on logistic regression and ROC curve

作　　者：黄珍 武东 黄迅 孙国君[1] HUANG Zhen;WU Dong;HUANG Xun;SUN Guo-jun(School of Pharmacy,Zhejiang University of Technology,Hangzhou ZHEJIANG 310000,China;Fuyang People’s Hospital,Fuyang ANHUI 236000,China;Tianjin University of Chinese Medicine,TIANJIN 301600,China)

机构地区：[1]浙江工业大学药学院,浙江杭州310000 [2]阜阳市人民医院,安徽阜阳236000 [3]天津中医药大学,天津301600

出　　处：《中国新药与临床杂志》2024年第1期51-56,共6页Chinese Journal of New Drugs and Clinical Remedies

基　　金：浙江省科技计划重点软科学研究项目(2022C25007);阜阳市卫生健康委科研项目(FY2021-010)。

摘　　要：目的探讨左西孟旦致心律失常的临床特点,分析可能的危险因素,并建立预测模型。方法回顾性收集2020年10月—2022年6月于某三甲医院接受左西孟旦治疗的643例出院患者的临床资料,分析发生心律失常的时间和类型,采用logistic回归分析和ROC曲线分析构建预测模型,另选取69例患者临床资料验证模型准确率。结果在643例出院患者中,94例(14.6%)发生心律失常,其中有82例(87%)发生在输液中及输液后2 d,以心房颤动(32%)最为常见。多因素logistic回归分析显示,用药后5 d内最低血钾、左室舒张末期内径(LV)扩大、微泵速度>0.2μg·kg^(-1)·min^(-1)是左西孟旦致心律失常发生的独立危险因素(均P<0.05),建立预测模型公式logit(P)=2.821-0.873×用药后5 d内最低血钾(0:>3.89 mmol·L^(-1);1:≤3.89 mmol·L^(-1))+0.697×LV(0:≤55 mm;1:>55 mm)-1.054×微泵速度>0.2μg·kg^(-1)·min^(-1)(0:否;1:是)。logit(P)截断值为0.91时,ROC曲线下面积为0.672(95%置信区间:0.627~0.715,P<0.001)。内部验证预测模型的准确率为83%。结论左西孟旦致心律失常发生率较高,输液后2 d内应加强心电监护。用药后5 d内血钾和微泵速度是可控因素,应加强干预,从而降低心律失常发生率。AIM To explore the clinical characteristics of levosimendan-induced arrhythmia,analyze the possible risk factors,and establish a prediction model.METHODS Clinical data of 643 discharged patients treated with levosimendan in a 3rd Grade Class A hospital from October 2020 to June 2022 were retrospectively collected and the time and type of arrhythmia were analyzed.Logistic regression analysis and ROC curve analysis were used to construct and evaluate the prediction model.Clinical data from another 69 patients were collected to verify the accuracy of the model.RESULTS Among 643 discharged patients,94 cases(14.6%)had arrhythmias,of which 82 cases(87%)occurred during infusion and 2 days after infusion,and atrial fibrillation(32%)was the most common.Multivariate logistic regression analysis showed that the lowest blood potassium within 5 days after medication,left ventricular end-diastolic diameter(LV),and micropump velocity>0.2μg·kg^(-1)·min^(-1) were independent risk factors for levosimendan-induced arrhythmia(all P<0.05),with the prediction model formula logit(P)=2.821-0.873×lowest serum potassium within 5 days after medication(0:>3.89mmol·L^(-1);1:≤3.89 mmol·L^(-1))+0.697×LV(0:≤55 mm;1:>55 mm)-1.054×micropump speed>0.2μg·kg^(-1)·min^(-1)(0:no;1:yes).When the cutoff value of logit(P)was 0.91,the area under the ROC curve was 0.672(95%confidence interval:0.627 to 0.715,P<0.001).The accuracy of the internal verification prediction model was 83%.CONCLUSION The incidence of arrhythmia induced by levosimendan is high,and ECG monitoring should be strengthened within 2 days after infusion.Blood potassium and micropump speed within 5 days after medication are controllable factors,and intervention should be strengthened to reduce the incidence of arrhythmia.

关 键 词：左西孟旦 心律失常 危险因素 LOGISTIC模型 ROC曲线 

分 类 号：R972[医药卫生—药品]