Hepatology:肝硬化患者手术后死亡率的新型风险预测模型

2020-10-29 MedSci原创 MedSci原创

背景及目的:先前数据显示肝硬化患者术后的死亡风险会增加。目前可用的预测术后风险的模型未达到最佳校准水平,无法将手术类型考虑进去。本研究目的是利用人群水平的数据来推导和内部验证新的肝硬化手术风险模型。

背景及目的:

先前数据显示肝硬化患者术后的死亡风险会增加。目前可用的预测术后风险的模型未达到最佳校准水平,无法将手术类型考虑进去。本研究目的是利用人群水平的数据来推导和内部验证新的肝硬化手术风险模型。

方法:

本篇研究进行的回顾性队列研究使用来自退伍军人肝病队列的数据,其中包含128个来自美国医疗中心的肝硬化患者的详细数据。研究人员将手术分类为腹壁手术、血管外科手术、腹部手术、心脏手术、胸部手术或整形外科手术,并使用多变量logistic回归模型对术后30天、90天和180天的死亡率进行建模(VOCAL-Penn模型)。我们将VOCAL-Penn的模型判别和校准与Mayo风险评分(MRS),MELD,MELD-Na和Child-Turcotte-Pugh(CTP)评分进行了比较。

结果:

本研究在3785例肝硬化患者中鉴定了4,712例外科手术方式。推导出新的VOCAL-Penn模型,并在内部进行了验证(术后30天的死亡率C统计量= 0.859,95%CI 0.809-0.909)。预测因素包括年龄、术前白蛋白、血小板计数、胆红素、手术类别、急诊适应症、脂肪肝、美国麻醉医师学会分类指标和肥胖。在鉴别和校准方面,模型性能在所有时间点均优于MELD,MELD-Na,CTP和MRS(例如,术后30天死亡率,MRS的C统计量= 0.766,95%CI为 0.676-0.855)。

结论:

VOCAL-Penn模型大大改善了对于肝硬化患者术后死亡率的预测。这些模型可在未来广泛应用以改善术前风险分层分析并优化患者对于手术方式的选择。

 

原始出处:

Nadim Mahmud, et al. Novel Risk Prediction Models for Post‐Operative Mortality in Patients with Cirrhosis. Hepatology. 2020.

 

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    2020-10-29 gwc384
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    2020-10-28 guging

    谢谢!最新的信息读起来就是收获大

    0

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    2020-10-28 CHANGE

    梅斯里提供了很多疾病的模型计算公式,赞一个!

    0

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