Objective To explore the risk factors associated with the prolonged length of stay in the intensive care unit(ICU-LOS)for patients with acute type A aortic dissection(ATAAD)by using propensity score matching,and to establish a Nomogram prediction model.Methods A total of 477 patients diagnosed with ATAAD who underwent surgery at the Department of Cardiac Surgery,Guangdong General Hospital from September 2017 to June 2021 were included.The clinical data of all the patients were collected,and the patients were divided into the ICU-LOS ≤8 days group(273 cases)and ICU-LOS＞8 days group(204 cases)according to whether ICU-LOS was more than 8 days.PSM method was employed to balance the clinical characteristics between the two groups.LASSO regression analysis was used to identify the risk factors related to prolonged ICU-LOS.Multivariate logistic regression analysis was performed to calculate odds ratios(ORs)between these the identified risk factors and ICU-LOS,followed by establishing a Nomogram prediction model.RCS curve analysis was conducted to assess the correlation between the prolongation of ICU-LOS and in-hospital mortality.Results After propensity score matching(PSM),the clinical data of the two groups were compared.The age,body mass index(BMI),hypertension,blood glucose,history of cardiovascular surgery,Marfan syndromes(MFS),white blood cell(WBC),platelet,D-dimer(D-Di)level,serum creatinine value,history of coronary artery bypass grafting(CABG),aortic cross clamp time and cardiopulmonary bypass time between the two groups showed statistically significant differences(P＜0.05).Multivariate logistic regression analysis revealed that MFS,BMI,white blood cell,cardiopulmonary bypass time and D-Di level were the independent risk factors for prolonged ICU-LOS among patients with ATAAD.The area under the receiver operating characteristic(ROC)curve of the Nomogram model was 0.72 and calibration curve demonstrate good agreement between the predicted values and actual values.Decision curve analysis(DCA)results indicated that when the risk threshold ranged from 0 to 0.7,the Nomogram model could effectively guide the clinical decisions regarding ICU length of stay.Restricted cubic spline(RCA)analysis showed that the risk of in-hospital death remained stable at around 8 days after admission to ICU for ATAAD patients(P＜0.001).When ICU-LOS was more than 8 days,the risk ratio of predicting in-hospital mortality was 1.02 for each additional standard deviation.Conclusion MFS,BMI,WBC,CPB time and D-Di are the influencing factors of prolonged ICU-LOS of ATAAD patients.The Nomogram prediction model of prolonged ICU length of stay for ATAAD patients exhibites good prediction ability and high consistency with actual events.This model holds promising application prospects as a tool to reduce hospitalization duration in ATAAD patients.
关键词
急性A型主动脉夹层动脉瘤/倾向性评分匹配/ICU停留时间/影响因素
Key words
Acute type A aortic dissection aneurysm/Propensity score method/Length of stay in ICU/Influencing factors
维普
万方数据