J Am Heart Assoc :心脏骤停临床预测模型有助于指导患者后续的治疗决策

2020-09-07 门诊杂志 门诊新视野

无论是在院外还是院内,突发心脏骤停(Sudden cardiac arrest,SCA)患者的存活率均明显偏低,存活患者预后神经系统良好的比例更是极低。

无论是在院外还是院内,突发心脏骤停(Sudden cardiac arrest,SCA)患者的存活率均明显偏低,存活患者预后神经系统良好的比例更是极低。由于SCA的突发性,在总体预后并不明朗时,很多作为代理决策者的患者家属都难以抉择下一步的治疗计划,如是否选择结束治疗、行气管切开术或经皮胃造瘘术及后续的紧急治疗等。在这种情况下,若能通过临床预测模型将倾向于预后不良或预后良好的患者群体区分开来,或将有助于明确决策方案。近期,Richard T. Carrick等人于JAHA发表的一项研究对过去近40年间发表的SCA临床预测模型(Clinical Predictive Model,CPM)及相关验证性研究进行了汇总分析,并对SCA CPM的预测有效性予以了回答。

新型突发心脏骤停临床预测模型中最常用的预测协变量是哪些?

研究人员共搜集了1981年7月至2020年2月间发表的81个独特的SCA临床预测模型研究报告:

55个(68%)模型用于预测院外心脏骤停(Out-of-hospital cardiac arrest,OHCA)患者的预后结果,17个(21%)用于预测院内心脏骤停(In-hospital cardiac arrest,IHCA)患者的预后结果,9个(11%)模型同时预测了上述两种情况。

9个(11%)模型用于预测早期结果,42个(52%)模型用于预测中期结果,28个(35%)预测的是长期结果。

31个(38%)模型在推导时纳入的是欧洲人群队列,24个(30%)纳入了北美人群队列,17个(21%)纳入了亚洲人群队列。

31个(38%)模型在建立时采用了前瞻性队列研究数据,49个(61%)模型使用了来自非前瞻性队列研究的数据。

33个(41%)模型发生了数据缺失(Missingness),27个(33%)模型报告了衍生队列(Derivation cohort)中的缺失数量。

各个模型构建时选择的算法亦不相同,35个(43%)使用了评分预测模型,29个(36%)采取了逻辑回归模型,16个(20%)选择了决策树模型。

衍生队列的中位样本大小为591(IQR,140-1028)。其中,低偏倚风险研究共计6项(7%),余下的75项(93%)均属于高偏倚风险。预测协变量数量的中位数为5个(IQR,3-6),各个模型研究中最常应用的3个协变量(covariate)为初始心律(n=51,63%)、年龄(n=42,52%)和心肺复苏时长(n=31,38%)(图1)。在所有报告区分度的模型(n=56,69%)中,中位C统计量(C-statistics)为0.84(IQR,0.80-0.89)。

图1. 临床预测模型的常用协变量

针对突发心脏骤停临床预测模型开展的验证性研究数据校准率偏低

研究人员共收集到了1997年4月至2020年2月间发表的62项SCA CPM验证性研究:上述81项新型SCA CPM中,33个(41%)模型至少被验证过1次,仅4个(5%)被验证了至少3次。经过最严格验证的3个模型分别为OHCA评分(OHCA score)、CAHP评分(cardiac arrest hospital prognosis score)和GO-FAR评分(good outcome following attempted resuscitation score)(表1)。

表1. 经过最严格验证的3项临床预测模型

除1项验证性研究外,上述62项验证性研究均报告了区分度(n=61,98%);中位C统计量为0.81(IQR,0.74-0.85)。然而,仅29项(47%)研究进行了数据校准。

在33项经过验证的模型中,共26个模型在衍生队列研究和验证队列研究中列出了区分度;这些模型的区分度中位变化百分比(median percentage change)为-1.6%(IQR,-10.6%~8.2%)(图2)。

图2. 区分度的变化百分比(部分模型被多次验证)

OHCA模型的区分度高于IHCA模型

进一步的分析结果显示,55个OHCA临床预测模型的中位衍生群体数量(median derivation population)为577(IQR,128-835),自变量事件数中位水平(median rate of events per variable)为17(IQR,8-56);17个IHCA临床预测模型的中位衍生群体数量为710(IQR,219-22,626),自变量事件数中位水平为35(IQR,9-515)。

OHCA模型(中位C统计量,0.85;IQR,0.82-0.90)的区分度明显高于IHCA模型(中位C统计量,0.78;IQR,0.75-0.80)。

总结与讨论

本项研究成功证明了利用多种模型预测SCA后的临床结果是可行的,与此同时,研究人员发现,新型SCA CPM的中位C统计量为0.84,这意味着通常情况下这些模型能够很好地区分预后较好或预后较差的SCA患者。这种强烈的区分度在外部验证期间亦得以维持,模型衍生和验证试验的对比结果指出,区分度的中位变化百分比仅为-1.6%,这与血管疾病其他领域的各种CPM形成了鲜明的对比。

此外,SCA CPM的一大特点在于它不仅可以根据患者的个体特征进行预测,还可根据某一特定患者所经历的心脏骤停特点进行预测;其中最常用的预测变量多特定于事件(如:心肺复苏时长、初始心律)而非特定于患者(如:年龄、性别)。另外,需要承认的是,少有CPM经过了严格验证,且多数验证性研究未进行数据校准。总体而言,尽管这些针对预后的定量评估手段可能有助于决策心脏骤停幸存者的护理方案,但临床医师仍应结合每个患者的整体临床情况进行最终的判断。

原始出处:

Richard T Carrick, Jinny G Park, Hannah L McGinnes, et al.Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances.J Am Heart Assoc. 2020 Aug 18;9(16):e017625. doi: 10.1161/JAHA.119.017625. Epub 2020 Aug 13.

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    2020-09-13 医路长长

    SCA的发生率升高!

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    2020-09-09 Lexi

    值得关注

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authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563368, encodeId=81c3156336802, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047848, encodeId=c8df104e8481f, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Sep 08 00:34:43 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883430, encodeId=11398834308f, content=<a href='/topic/show?id=9c1851e0334' target=_blank style='color:#2F92EE;'>#心脏骤停#</a><a href='/topic/show?id=804d1038e293' target=_blank style='color:#2F92EE;'>#临床预测模型#</a>, 研究不同模型之间的差异,优化模型, beContent=null, objectType=article, channel=null, level=null, likeNumber=192, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51703, encryptionId=9c1851e0334, topicName=心脏骤停), TopicDto(id=103872, encryptionId=804d1038e293, topicName=临床预测模型)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Sep 07 22:35:22 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883420, encodeId=064188342092, content=…, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200907/8844febe032740debda25b92a1fc2420/5d0a5400961e41fba1929dcbe92225a7.jpg, createdBy=45f55415677, createdName=舒同学, createdTime=Mon Sep 07 22:15:06 CST 2020, time=2020-09-07, status=1, ipAttribution=)]
  4. 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authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563368, encodeId=81c3156336802, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047848, encodeId=c8df104e8481f, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Sep 08 00:34:43 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883430, encodeId=11398834308f, content=<a href='/topic/show?id=9c1851e0334' target=_blank style='color:#2F92EE;'>#心脏骤停#</a><a href='/topic/show?id=804d1038e293' target=_blank style='color:#2F92EE;'>#临床预测模型#</a>, 研究不同模型之间的差异,优化模型, beContent=null, objectType=article, channel=null, level=null, likeNumber=192, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51703, encryptionId=9c1851e0334, topicName=心脏骤停), TopicDto(id=103872, encryptionId=804d1038e293, topicName=临床预测模型)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Sep 07 22:35:22 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883420, encodeId=064188342092, content=…, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200907/8844febe032740debda25b92a1fc2420/5d0a5400961e41fba1929dcbe92225a7.jpg, createdBy=45f55415677, createdName=舒同学, createdTime=Mon Sep 07 22:15:06 CST 2020, time=2020-09-07, status=1, ipAttribution=)]
    2020-09-09 zhaojie88
  5. 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  6. 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authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563368, encodeId=81c3156336802, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047848, encodeId=c8df104e8481f, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Sep 08 00:34:43 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883430, encodeId=11398834308f, content=<a href='/topic/show?id=9c1851e0334' target=_blank style='color:#2F92EE;'>#心脏骤停#</a><a href='/topic/show?id=804d1038e293' target=_blank style='color:#2F92EE;'>#临床预测模型#</a>, 研究不同模型之间的差异,优化模型, beContent=null, objectType=article, channel=null, level=null, likeNumber=192, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51703, encryptionId=9c1851e0334, topicName=心脏骤停), TopicDto(id=103872, encryptionId=804d1038e293, topicName=临床预测模型)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Sep 07 22:35:22 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883420, encodeId=064188342092, content=…, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200907/8844febe032740debda25b92a1fc2420/5d0a5400961e41fba1929dcbe92225a7.jpg, createdBy=45f55415677, createdName=舒同学, createdTime=Mon Sep 07 22:15:06 CST 2020, time=2020-09-07, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=884970, encodeId=3e908849e0a8, content=SCA的发生率升高!, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210722/aa17ab53f7294b12ad504c0277c2fa9a/c4671154a46d481a8d36d1dd00007e0e.jpg, createdBy=a8875280961, createdName=医路长长, createdTime=Sun Sep 13 17:39:36 CST 2020, time=2020-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883941, encodeId=ccf588394175, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Wed Sep 09 18:26:48 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262792, encodeId=d4d31262e9277, content=<a href='/topic/show?id=52941002359d' target=_blank style='color:#2F92EE;'>#预测模型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100235, encryptionId=52941002359d, topicName=预测模型)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357600, encodeId=3bbb135e600f1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535885, encodeId=d1ce153588531, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541863, encodeId=90bd1541863e9, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563368, encodeId=81c3156336802, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047848, encodeId=c8df104e8481f, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Sep 08 00:34:43 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883430, encodeId=11398834308f, content=<a href='/topic/show?id=9c1851e0334' target=_blank style='color:#2F92EE;'>#心脏骤停#</a><a href='/topic/show?id=804d1038e293' target=_blank style='color:#2F92EE;'>#临床预测模型#</a>, 研究不同模型之间的差异,优化模型, beContent=null, objectType=article, channel=null, level=null, likeNumber=192, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51703, encryptionId=9c1851e0334, topicName=心脏骤停), TopicDto(id=103872, encryptionId=804d1038e293, topicName=临床预测模型)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Sep 07 22:35:22 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883420, encodeId=064188342092, content=…, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200907/8844febe032740debda25b92a1fc2420/5d0a5400961e41fba1929dcbe92225a7.jpg, createdBy=45f55415677, createdName=舒同学, createdTime=Mon Sep 07 22:15:06 CST 2020, time=2020-09-07, status=1, ipAttribution=)]
    2020-09-09 slcumt
  8. 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time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535885, encodeId=d1ce153588531, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541863, encodeId=90bd1541863e9, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563368, encodeId=81c3156336802, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047848, encodeId=c8df104e8481f, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Sep 08 00:34:43 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883430, encodeId=11398834308f, content=<a href='/topic/show?id=9c1851e0334' target=_blank style='color:#2F92EE;'>#心脏骤停#</a><a href='/topic/show?id=804d1038e293' target=_blank style='color:#2F92EE;'>#临床预测模型#</a>, 研究不同模型之间的差异,优化模型, beContent=null, objectType=article, channel=null, level=null, likeNumber=192, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51703, encryptionId=9c1851e0334, topicName=心脏骤停), TopicDto(id=103872, encryptionId=804d1038e293, topicName=临床预测模型)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Sep 07 22:35:22 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883420, encodeId=064188342092, content=…, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200907/8844febe032740debda25b92a1fc2420/5d0a5400961e41fba1929dcbe92225a7.jpg, createdBy=45f55415677, createdName=舒同学, createdTime=Mon Sep 07 22:15:06 CST 2020, time=2020-09-07, status=1, ipAttribution=)]
    2020-09-08 CHANGE

    梅斯里提供了很多疾病的模型计算公式,赞一个!

    0

  9. 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time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535885, encodeId=d1ce153588531, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541863, encodeId=90bd1541863e9, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563368, encodeId=81c3156336802, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Sep 09 12:34:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047848, encodeId=c8df104e8481f, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Sep 08 00:34:43 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883430, encodeId=11398834308f, content=<a href='/topic/show?id=9c1851e0334' target=_blank style='color:#2F92EE;'>#心脏骤停#</a><a href='/topic/show?id=804d1038e293' target=_blank style='color:#2F92EE;'>#临床预测模型#</a>, 研究不同模型之间的差异,优化模型, beContent=null, objectType=article, channel=null, level=null, likeNumber=192, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51703, encryptionId=9c1851e0334, topicName=心脏骤停), TopicDto(id=103872, encryptionId=804d1038e293, topicName=临床预测模型)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Sep 07 22:35:22 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883420, encodeId=064188342092, content=…, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200907/8844febe032740debda25b92a1fc2420/5d0a5400961e41fba1929dcbe92225a7.jpg, createdBy=45f55415677, createdName=舒同学, createdTime=Mon Sep 07 22:15:06 CST 2020, time=2020-09-07, status=1, ipAttribution=)]
    2020-09-07 lovetcm

    #心脏骤停##临床预测模型#, 研究不同模型之间的差异,优化模型

    0

  10. 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    2020-09-07 舒同学

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