Construction and validation of risk prediction model for serious adverse events in adult patients with congenital heart disease complicated with pulmonary hypertension after cardiac catheterization
Objective To construct a risk prediction score model for serious adverse event(SAE)after cardiac catheterization in patients with adult congenital heart disease(ACHD)and pulmonary hypertension(PH)and verify its predictive effect.Methods The patients with PH who underwent cardiac catheterization in Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to January 2022 were retrospectively collected.The patients were randomly divided into a model group and a validation group according to the order of admission.The model group was divided into a SAE group and a non-SAE group according to whether SAE occurred after the catheterization.The data of the two groups were compared,and the risk prediction score model was established according to the results of multivariate logistic regression analysis.The discrimination and calibration of the model were evaluated using the area under the receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow test,respectively.Results A total of 758 patients were enrolled,including 240(31.7％)males and 518(68.3％)females,with a mean age of 43.1(18.0-81.0)years.There were 530 patients in the model group(47 patients in the SAE group and 483 patients in the non-SAE group)and 228 patients in the validation group.Univariate analysis showed statistical differences in age,smoking history,valvular disease history,heart failure history,N-terminal pro-B-type natriuretic peptide,and other factors between the SAE and non-SAE groups(P＜0.05).Multivariate analysis showed that age≥ 50 years,history of heart failure,moderate to severe congenital heart disease,moderate to severe PH,cardiac catheterization and treatment,surgical general anesthesia,and N-terminal pro-B-type natriuretic peptide≥ 126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients(P＜0.05).The risk prediction score model had a total score of 0-139 points and patients who had a score＞50 points were high-risk patients.Model validation results showed an area under the ROC curve of 0.937(95％ CI 0.897-0.976).Hosmer-Lemeshow goodness-of-fit test:x2=3.847,P=0.797.Conclusion Age≥50 years,history of heart failure,moderate to severe congenital heart disease,moderate to severe PH,cardiac catheterization and treatment,general anesthesia for surgery,and N-terminal pro-B-type natriuretic peptide≥ 126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients.The risk prediction model based on these factors has a high predictive value and can be applied to the risk assessment of SAE after interventional therapy in ACHD-PH patients to help clinicians perform early intervention.
Adult congenital heart diseasepulmonary hypertensioncatheterizationserious adverse eventrisk prediction model
万方数据
维普
