急性主动脉夹层术后院内死亡风险预测模型的构建

Prediction Model for Hospitalized Death in Patients with Acute Aortic Dissection after Operation

目的:分析急性主动脉夹层(AAD)患者术后院内死亡危险因素,建立死亡风险预测模型。方法:收集256例经手术治疗的AAD患者临床资料,采用Logistic单因素和多因素回归分析筛选Stanford A型和B型患者术后死亡相关因素,建立死亡风险预测模型并对模型进行评价。结果:AAD患者院内死亡率为12.11%(31/256)。多因素分析显示,窦部受累和并发急性肾衰竭是A型患者术后院内死亡的独立危险因素,年龄较大和并发急性肾衰竭是B型患者术后院内死亡的独立危险因素,纤维蛋白原(FIB)升高是B型患者的独立保护因素。进一步构建了列线图预测模型,经Homser-Lemeshow统计量检验,A型预测模型(χ^(2)=0.383,P=0.536)和B型预测模型(χ^(2)=7.292,P=0.505)拟合效果均较好。A型和B型预测模型受试者工作特征曲线下面积分别为0.722(P<0.01)和0.938(P<0.01)。结论:基于窦部受累和并发急性肾衰竭构建的Stanford A型术后院内死亡风险预测模型,以及基于年龄、并发急性肾衰竭和FIB的Stanford B型术后院内死亡风险预测模型均具有较好的预测性能。

Objective:To analyze the risk factors for hospitalized death in patients with acute aortic dissection(AAD)after operation and set up risk prediction models.Methods:The clinical data of 256 patients with AAD were collected.Univariate and multivariate logistic regression analysis were used to screen the related factors of postoperative death in Stanford type A and type B patients.The mortality risk prediction model was established and evaluated.Results:The in-hospital mortality of AAD patients was 12.11%(31/256).Multivariate analysis showed that sinus involvement and acute renal failure were independent risk factors for postoperative hospital death in type A patients,older age and acute renal failure were independent risk factors for postoperative hospital death in type B patients,and higher fibrinogen(FIB)was an independent protective factor for type B patients.Furthermore,the nomogram prediction model was constructed and tested by Homser-Lemeshow statistics.The fitting effect of type A prediction model(χ^(2)=0.383,P=0.536)and type B prediction model(χ^(2)=7.292,P=0.505)were both good.The areas under the receiver operating characteristic curve of type A and type B prediction models were 0.722(P<0.01)and 0.938(P<0.01),respectively.Conclusion:The risk prediction models of postoperative in-hospital death in patients with ADD,including Stanford type A based on sinus involvement and acute renal failure,as well as Stanford type B based on age,acute renal failure and FIB,both have good prediction performance.