基于血清标志物、临床资料构建心搏骤停患者心肺复苏后死亡的nomogram预测模型  

Nomogram Prediction Model for Death of Patients with Sudden Cardiac Arrest after Cardiopulmonary Resuscitation Based on Serum Markers and Clinical Data

作　　者：张培培 李婷婷 许兴超 王娜[1] ZHANG Peipei;LI Tingting;XU Xingchao;WANG Na(Heart Intensive Care Unit of Zhoukou Central Hospital,Zhoukou 466000,China)

机构地区：[1]周口市中心医院心脏重症监护室,周口466000

出　　处：《福建医科大学学报》2025年第1期31-38,共8页Journal of Fujian Medical University

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190132)。

摘　　要：目的基于血清标志物、临床资料构建心搏骤停(SCA)患者心肺复苏后死亡的nomogram预测模型。方法选取2021年1月-2023年12月SCA心肺复苏后自主循环恢复患者145例作为建模群,统计患者出院时的预后情况。根据出院时的预后情况将患者分为死亡组和存活组,比较2组患者的临床资料和血清标志物。通过Lasso回归和logistic回归分析SCA心肺复苏后自主循环恢复患者死亡的影响因素,根据影响因素构建死亡的nomogram预测模型,并分析该模型的预测效能和临床效用。结果145例SCA心肺复苏后自主循环恢复患者的死亡率为57.93%(84/145)。死亡组的年龄、心肺复苏时间、停搏时间、复苏后抽搐或痉挛占比、复苏后急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、复苏后感染相关器官功能衰竭评分系统(SOFA)评分、血清脑钠肽(BNP)、乳酸脱氢酶(LDH)、细胞角蛋白(CK)、心肌肌钙蛋白T(cTnT)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)水平等均高于存活组;可除颤心率占比、肾上腺素用量<5 mg占比、血清细胞因子信号转导抑制因子2(SOCS2)水平则低于存活组(P<0.05)。心肺复苏时间、停搏时间、复苏后SOFA评分、血清BNP、LDH、CK、cTnT、IL-6、hs-CRP、SOCS2、D-D水平均为SCA心肺复苏后自主循环恢复患者死亡的影响因素(P<0.05)。根据以上影响因素构建SCA心肺复苏后自主循环恢复患者死亡的nomogram预测模型,该模型预测SCA心肺复苏后自主循环恢复患者死亡的曲线下面积(AUC)为0.921(95%CI:0.878~0.965),预测灵敏度和特异度分别为87.35%和80.26%。外部验证显示,nomogram预测模型预测SCA心肺复苏后自主循环恢复患者死亡的AUC为0.958(95%CI:0.909~1.000),预测灵敏度和特异度分别为88.89%和89.06%,具有较高的临床效用准确性。结论基于血清标志物和临床资料构建SCA患者心肺复苏后死亡的nomogram预测模型,可为临�Objective To construct a nomogram prediction model for death of patients with sudden cardiac arrest(SCA)after cardiopulmonary resuscitation based on serum markers and clinical data.Methods A total of 145 patients with recovery of autonomous circulation after cardiopulmonary resuscitation in SCA from January 2021 to December 2023 were selected as the modeling group.The prognosis at discharge was statistically analyzed.Patients were divided into a death group and a survival group according to their prognosis at discharge.The clinical data and serum markers of the two groups were compared.The factors influencing the death of patients with recovery of autonomous circulation after cardiopulmonary resuscitation in SCA were analyzed using Lasso regression and logistic regression.A nomogram prediction model for death was constructed based on the influencing factors.And the predictive efficacy and clinical utility of the nomogram prediction model were analyzed.Results The mortality rate of 145 patients with recovery of autonomous circulation after SCA cardiopulmonary resuscitation was 57.93%(84/145).The age,cardiopulmonary resuscitation time,arrest time,proportion of post-resuscitation convulsions or spasms,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,post-resuscitation sepsis-related organ failure assessment(SOFA)score,serum brain natriuretic peptide(BNP),lactate dehydrogenase(LDH),cytokeratin(CK),cardiac troponin T(cTnT),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),and D-dimer(D-D)levels in the death group were higher than those in the survival group,while the proportion of defibrillation rate,the proportion of adrenaline dose<5 mg,and the level of serum suppressors of cytokine signaling 2(SOCS2)were lower than those in the survival group(P<0.05).The time of cardiopulmonary resuscitation,the time of cardiac arrest,the post-resuscitation SOFA score,the levels of serum BNP,LDH,CK,cTnT,IL-6,hs-CRP,SOCS2,and D-D were the influencing factors for death in patients with recovery of auton

关 键 词：心搏骤停 心肺复苏 自主循环 恢复 死亡 nomogram预测模型 

分 类 号：R459.7[医药卫生—急诊医学]