急性A型主动脉夹层动脉瘤患者ICU停留时间延长的危险因素分析及预测模型的建立  

Analysis of risk factors of prolonged stay in ICU for patients with acute type A aortic dissection and construction of a predictive model

作　　者：李晨曦 王秋吉 杨珏[3] 李欣[3] 范瑞新[3] LI Chen-xi;WANG Qiu-ji;YANG Jue;LI Xin;FAN Rui-xin(Department of cardiac surgery intensive care unit,Guangdong cardiovascular institute,Guangdong provincial people’s hospital,Southern medical university,Guangzhou 510080,China;Department of vascular and coronary surgery,Guangdong cardiovascular institute,Guangdong provincial people’s hospital,Southern medical university,Guangzhou 510080,China;Department of cardiovascular surgery,Guangdong cardiovascular institute,Guangdong provincial people’s hospital,Southern medical university,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,广东省人民医院,南方医科大学心外重症监护室,广东省广州市510080 [2]广东省心血管病研究所,广东省人民医院,南方医科大学瓣膜与冠心病外科,广东省广州市510080 [3]广东省心血管病研究所,广东省人民医院,南方医科大学心脏大血管外科,广东省广州市510080

出　　处：《中国心血管病研究》2024年第12期1118-1124,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的应用倾向性评分匹配(PSM)分析导致ATAAD患者ICU停留时间(ICU-LOS)延长的危险因素,并建立列线图(Nomogram)预测模型。方法回顾性纳入2017年9月至2021年6月在广东省人民医院心外科诊断为ATAAD并行外科手术的477例患者,收集患者的一般情况及临床资料等数据,根据ICU-LOS是否超过8 d,将患者分为ICU-LOS≤8 d组(273例)和ICU-LOS>8 d组(204例),使用PSM法均衡两组临床特征。应用LASSO回归筛选与ICU-LOS延长相关的危险因素,采用多元logistic回归计算所筛选出的危险因素与ICU-LOS之间的比值比(OR),并建立Nomogram预测模型。应用RCS曲线分析ICU-LOS延长与院内病死率的相关性。结果两组患者的临床资料经过PSM后,年龄、体重指数(BMI)、高血压、血糖、心血管手术史、马方综合征(MFS)、白细胞、血小板、D-二聚体(D-Di)、血清肌酐值、冠状动脉旁路移植史(CABG)、主动脉交叉夹闭(ACC)时间、体外循环(CPB)时间差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,MFS、BMI、WBC、CPB时间和D-Di是引起TAAD患者ICU停留时间延长的独立危险因素。将结果建立Nomogram预测模型,该模型的ROC曲线下面积为0.72,校正曲线显示预测值与实际值吻合较好。DCA结果表明,当风险阈值约为0~0.7时,Nomogram模型可以对ICU-LOS做出有效的临床决策。RCS结果显示,院内死亡风险在8 d左右保持稳定(P<0.001)。当ICU-LOS>8 d时,每增加一个标准差,院内死亡的预测风险比为1.02。结论MFS、BMI、WBC、CPB时间、D-Di是ATAAD患者ICU-LOS延长的影响因素。本研究构建的TAAD患者ICU停留时间延长的Nomogram预测模型具有较好的预测能力,预测事件与实际事件的一致性较高。作为缩短TAAD患者住院时间的工具,该模型具有广阔的应用前景。Objective To explore the risk factors associated with the prolonged length of stay in the intensive care unit(ICU-LOS)for patients with acute type A aortic dissection(ATAAD)by using propensity score matching,and to establish a Nomogram prediction model.Methods A total of 477 patients diagnosed with ATAAD who underwent surgery at the Department of Cardiac Surgery,Guangdong General Hospital from September 2017 to June 2021 were included.The clinical data of all the patients were collected,and the patients were divided into the ICU-LOS≤8 days group(273 cases)and ICU-LOS>8 days group(204 cases)according to whether ICU-LOS was more than 8 days.PSM method was employed to balance the clinical characteristics between the two groups.LASSO regression analysis was used to identify the risk factors related to prolonged ICU-LOS.Multivariate logistic regression analysis was performed to calculate odds ratios(ORs)between these the identified risk factors and ICU-LOS,followed by establishing a Nomogram prediction model.RCS curve analysis was conducted to assess the correlation between the prolongation of ICU-LOS and in-hospital mortality.Results After propensity score matching(PSM),the clinical data of the two groups were compared.The age,body mass index(BMI),hypertension,blood glucose,history of cardiovascular surgery,Marfan syndromes(MFS),white blood cell(WBC),platelet,D-dimer(D-Di)level,serum creatinine value,history of coronary artery bypass grafting(CABG),aortic cross clamp time and cardiopulmonary bypass time between the two groups showed statistically significant differences(P<0.05).Multivariate logistic regression analysis revealed that MFS,BMI,white blood cell,cardiopulmonary bypass time and D-Di level were the independent risk factors for prolonged ICU-LOS among patients with ATAAD.The area under the receiver operating characteristic(ROC)curve of the Nomogram model was 0.72 and calibration curve demonstrate good agreement between the predicted values and actual values.Decision curve analysis(DCA)results indicated tha

关 键 词：急性A型主动脉夹层动脉瘤 倾向性评分匹配 ICU停留时间 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]