心原性休克患者短期预后影响因素分析及预测列线图构建

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目的:分析影响心原性休克患者短期预后的相关因素,并以列线图形式构建新疆地区心原性休克患者30 d死亡风险的预测模型。方法:回顾性分析新疆医科大学第一附属医院2013—2019年295例心原性休克患者的临床资料。采用单因素和多因素Logistic回归分析影响心原性休克患者30 d死亡的危险因素,并使用列线图构建心原性休克患者死亡风险的预测模型,采用一致性系数和受试者工作特征(ROC)曲线评估模型的优劣性。结果:295例患者中,30 d死亡182例为死亡组,未发生死亡113例为生存组。死亡组与生存组性别构成、年龄、ICU时间、收缩压、白细胞、中性粒细胞计数、红细胞分布宽度(RDW)、凝血酶原时间、血钾、血糖、血肌酐、总胆红素、碳酸氢根、碱剩余、乳酸、脑钠肽前体(NT-proBNP)、心肌肌钙蛋白(cTnI)及呼吸衰竭、肝病、肾病比例比较差异有统计学意义(n P<0.01或<0.05)。多因素Logistic回归分析结果显示,NT-proBNP、凝血酶原时间、cTnI、乳酸和收缩压为心原性休克患者死亡的独立危险因素(n OR = 1.00、1.10、1.30、1.29和1.04,95% n CI 1.00~1.00、1.01~1.18、1.00~1.68、1.01~1.65和1.02~1.07,n P<0.01或<0.05)。对多因素分析得到的独立影响因素再结合临床实际,进行赤池信息量准则(AIC)分析选择建模变量,纳入列线图模型的变量为NT-proBNP、凝血酶原时间、cTnI和乳酸。列线图模型在经过500次Bootstrap自抽样内部验证后,得到的C指数为0.805,曲线下面积为0.846,最佳阈值0.486,灵敏度为78.6%,特异度为83.1%。n 结论:NT-proBNP、凝血酶原时间、cTnI和乳酸为心原性休克患者短期预后的相关影响因素,并构建了相关列线图预测模型,对心原性休克的早期干预具有指导意义。“,”Objective:To analyze the influencing factors of short-term prognosis, and construct a 30-day mortality risk prediction model for patients with cardiogenic shock in Xinjiang region with nomogram.Methods:The clinical data of 295 patients with cardiogenic shock from 2013 to 2019 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. Univariate and multivariate Logistic regression were used to analyze the risk factors for 30-day death in patients with cardiogenic shock, the nomogram was used to construct a prediction model for the risk of death in patients with cardiogenic shock, and the consistency coefficient and receiver operating characteristic (ROC) curve were used to evaluate the model.Results:Among 295 patients, 182 died at 30 d (death group) and 113 survived (survival group). There were statistical differences in gender, age, ICU time, systolic blood pressure, white blood cell, neutrophil count, red blood cell distribution width (RDW), prothrombin time, potassium, blood glucose, serum creatinine, total bilirubin, bicarbonate, base excess, lactic acid, brain natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI) and the percentage of respiratory failure, liver disease, kidney disease between death group and survival group (n P<0.01 or<0.05). Multivariate Logistic regression analysis results showed that NT-proBNP, prothrombin time, cTnI, lactic acid and systolic blood pressure were independent risk factors of death in patients with cardiogenic shock (n OR = 1.00, 1.10, 1.30, 1.29 and 1.04; 95% n CI 1.00 to 1.00, 1.01 to 1.18, 1.00 to 1.68, 1.01 to 1.65 and 1.02 to 1.07; n P<0.01 or<0.05). The independent factors obtained from multivariate analysis were combined with clinical practice, Akaike information criterion (AIC) analysis was conducted to select modeling variables, and the variables included in the nomogram model were NT-proBNP, prothrombin time, cTnI and lactic acid. After 500 times of internal Bootstrap self-sampling verification of the nomogram model, the C index was 0.805, area under the curve was 0.846, and the optimum threshold value was 0.486, with a sensitivity of 78.6% and a specificity of 83.1%.n Conclusions:NT-proBNP, prothrombin time, cTnI and lactic acid are the related influencing factors for the short-term prognosis of patients with cardiogenic shock, and the related nomogram prediction model is constructed, which has guiding significance for the early intervention of cardiogenic shock.
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