Circulation:对CREST模型早期预测非STEMI患者心脏骤停后循环病因学死亡风险的推导和验证。

2017-11-23 fengxiangxin MedSci原创

无ST段抬高型心肌梗死(STEMI)患者在进行心肺复苏成功后,尚没有实用工具可以立即量化其循环病因学死亡(CED)的风险。为了快速确定风险并促进将患者分类到个性化治疗途径中,研究者开发并验证了他们的预测模型。

无ST段抬高型心肌梗死(STEMI)患者在进行心肺复苏成功后,尚没有实用工具可以立即量化其循环病因学死亡(CED)的风险。为了快速确定风险并促进将患者分类到个性化治疗途径中,研究者开发并验证了他们的预测模型。

研究者使用了国际心脏骤停注册中心(INTCAR)的相关数据集,他们将患者分为CED、CED合并神经病因学死亡或存活。首先,使用人口统计学和临床因素建立了推导队列,并使用向后逐步逻辑回归来识别与CED独立相关的因素。然后在推导队列和验证队列中使用曲线下面积(AUC)和Hosmer Lemeshow检验来测试模型性能,并且指定了一个简化的评分系统。

在推导队列的638名患者中,121名(18.9%)患者已发生CED。 最终模型包括以下几个相关因素:先前存在冠心病(C)(OR = 2.86,CI 1.83-4.49,p = <0.001),非休克性心律失常(R)(OR = 1.75,CI 1.10-2.77,p = 0.017),初始射血分数<30% (E)(OR = 2.11,CI 1.32-3.37,p=0.002),报道发生过休克(S)(OR=2.27,CI 1.42-3.62, p<0.001)和缺血时间> 25分钟(T)(OR = 1.42,CI 0.90-2.23,p = 0.13) 。推导模型的AUC为0.73,Hosmer Lemeshow检验p = 0.47。

在包含318例患者的验证队列中有相似的结果(AUC 0.68,Hosmer Lemeshow检验p = 0.41)。当在推导模型中为每个相关因子指定一个得分时(即CREST评分分别为0-5时),CED的平均预测 vs 观察概率是:7.1vs10.2%,9.5vs11%,22.5vs19.6%,32.4vs29.6%,38.5vs30%和55.7%vs50%

结论:CREST模型可在复苏后根据循环病因学死亡风险对患者立即进行危险分层,可使用该工具估计循环风险,并且在紧急时刻提供对无STEMI的CA幸存者的分流依据。

原始出处:

Bascom KE, Dziodzio J.et al.Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients without STEMI after Cardiac Arrest.Circulation. 2017 Oct 26. pii: CIRCULATIONAHA.116.024332. doi: 10.1161/CIRCULATIONAHA.116.024332.

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    2017-11-26 大爰

    学习了谢谢分享!!

    0

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    2017-11-25 HinsMax

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