经皮冠脉介入治疗术后患者住院期间死亡风险模型的预测价值  

The predictive value of patient risk model of death during hospitalization after percutaneous coronary intervention

作　　者：许秉正 王斌[1] 吴晓雅 许金刚 陈剑平[1] Xu Bingzheng

机构地区：[1]温州医学院附属东阳医院,322100

出　　处：《浙江临床医学》2024年第11期1625-1628,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省金华市科技计划项目(2022-4-260)。

摘　　要：目的识别急诊经皮冠脉介入治疗(PCI)术后住院期间高死亡风险的患者,并尽早进行干预以减少死亡率。方法收集2013年6月1日至2021年12月31日在本院住院的急诊PCI术后患者临床资料,包括收缩压、心率及相关血液指标。采用LASSO回归及逐步回归分析确定死亡风险的相关因素,并构建列线图模型,采用受试者工作特征曲线(ROC曲线)下面积(AUC)评估模型的准确度,通过校准图(GiViTI图)评估模型的校准度,并通过Decline Curve Analysis(DCA)评估预测模型的临床价值。采用Bootstrap方法进行内部验证。结果急诊PCI术后首次检测的B型前脑利尿钠肽(BNP)、白细胞、收缩压、D-二聚体水平,以及入院时是否出现呼吸衰竭,均与患者的死亡风险密切相关(P<0.05)。模型建立后,AUC值为0.944,校准图的P值为0.700,Brier scaled为0.029,calibration slope为1.000,R2为0.500,DCA曲线位于两条极端曲线之上。内部验证结果表明,校正曲线与理想曲线重合度很高。结论入院后BNP、白细胞计数、收缩压、D-二聚体的检测结果,以及是否出现呼吸衰竭,是急诊PCI术后患者住院期间死亡的重要危险因素。基于这些指标构建的预测模型在评估这类患者住院期间死亡风险方面有较高的临床意义。Objective To identify patients at high risk of death during hospitalization after emergency percutaneous coronary intervention(PCI)and to intervene early to reduce mortality.Methods Clinical data of patientswho underwent emergency PCI and were hospitalized at Dongyang People's Hospital from June 1,2013,to December 31,2021,were collected.This included systolic blood pressure,heart rate,and related blood indicators.LASSO regression and stepwise regression analysis were used to determine the factors associated with the risk of death,and a nomogram model was constructed.The accuracy of the model was assessed using the area under the receiver operating characteristic curve(AUC),the calibration was evaluated using the calibration plot(GiViTI plot),and the clinical value of the predictive model was assessed through Decline Curve Analysis(DCA).Additionally,internal validation was performed using the bootstrap method.Results The first detection of B-type natriuretic peptide(BNP),white blood cell count,systolic blood pressure,Ddimer levels,and the presence of respiratory failure at admission were all closely related to the risk of death in patients after emergency PCI(P<0.05).After the model was established,the AUC value was 0.944,the P-value for the calibration plot was 0.700,Brier scaled was 0.029,the calibration slope was 1.000,R2 was 0.500,and the DCA curve was above the two extreme curves.The internal validation results showed a high degree of overlap between the corrected curve and the ideal curve.Conclusion The detection results of B-type natriuretic peptide(BNP),white blood cell count,systolic blood pressure,D-dimer,and the presence of respiratory failure upon admission are significant risk factors for death in patients after emergency PCI during hospitalization.The predictive model constructed based on these indicators has high clinical significance in assessing the risk of death for such patients during hospitalization.

关 键 词：心肌梗死 危险因素 预后 诺模图 逐步回归分析 

分 类 号：R541.4[医药卫生—心血管疾病]