急性心肌梗死合并心源性休克发生院内死亡预测模型的建立
Development of a predictive model for in-hospital death in acute myocardial infarction combined with cardiogenic shock
李金滨 1全美玲 2李晓雪1
作者信息
- 1. 157000 牡丹江,牡丹江心血管病医院急诊科
- 2. 157000 牡丹江,牡丹江心血管病医院心内科
- 折叠
摘要
目的 分析急性心肌梗死合并心源性休克(AMICS)发生院内死亡的影响因素并建立预测模型.方法 选取2020年1月至2022年6月于牡丹江心血管病医院收治的251例AMICS患者,根据院内生存结局分为死亡组和存活组.收集AMICS患者临床资料,采用单因素和多因素Logistic回归分析AMICS患者院内死亡的影响因素并构建预测模型,采用受试者工作特征(ROC)曲线分析AMICS患者院内死亡预测模型的预测价值.结果 251例AMICS患者院内死亡率为38.65%(97/251).单因素分析显示,死亡组年龄≥60岁比例和乳酸(Lac)、心肌肌钙蛋白I、脑钠肽(BNP)、D-二聚体(D-dimer)、血肌酐、血尿素氮(BUN)水平高于存活组,收缩压(SBP)、左室射血分数(LVEF)低于存活组(P＜0.05).多因素Logistic回归分析显示,年龄≥60岁和Lac、BNP、D-dimer、BUN升高为AMICS患者院内死亡的独立危险因素,SBP、LVEF升高为独立保护因素(P＜0.05).AMICS患者院内死亡的预测模型方程:y=1.246-0.757×年龄-0.053×SBP-0.073×LVEF+0.565×Lac+0.005×BNP+0.554×D-dimer+0.179×BUN.ROC曲线分析显示,该预测模型预测AMICS患者院内死亡的曲线下面积为0.905,敏感度和特异度分别为79.38%、88.96%.结论 基于年龄、SBP、LVEF、Lac、BNP、D-dimer和BUN构建的AMICS患者院内死亡的预测模型,对AMICS患者院内死亡的预测价值较高.
Abstract
Objective To analyze the factors influencing the occurrence of in-hospital death in acute myocardial infarction combined with cardiogenic shock(AMICS)and to develop a predictive model.Methods A total of 251 AMICS patients admitted to our hospital from January 2020 to June 2022 were selected and divided into a death group and a survival group based on in-hospital survival outcomes.The clinical data of AMICS patients were collected,the factors influencing in-hospital mortality in AMICS patients were analyzed using univariate and multi-factor logistic regression and the predictive model was constructed.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of the in-hospital mortality prediction model for AMICS patients.Results In-hospital mortality in 251 AMICS patients was 38.65%(97/251).Univariate analysis showed that the proportion of age≥60 years and the levels of lactate(Lac),cardiac troponin I,B-type natriuretic peptide(BNP),D-dimer,blood creatinine and blood urea nitrogen(BUN)were higher in the death group than in the survival group,and systolic blood pressure(SBP)and left ventricular ejection fraction(LVEF)were lower than in the survival group(P<0.05).Multi-factor logistic regression analysis showed that age≥60 years and elevated Lac,BNP,D-dimer and BUN were independent risk factors for in-hospital mortality in AMICS patients,and elevated SBP and LVEF were independent protective factors(P<0.05).Predictive model equation for in-hospital mortality in AMICS patients:y=1.246-0.757×age-0.053×SBP-0.073×LVEF+0.565×Lac+0.005×BNP+0.554×D-dimer+0.179×BUN.ROC curve analysis showed that the area under the curve of this predictive model for predicting in-hospital mortality in AMICS patients was 0.905,with a sensitivity and specificity of 79.38%and 88.96%,respectively.ROC curve analysis showed that the area under the curve of this predictive model for predicting in-hospital mortality in AMICS patients was 0.905,with a sensitivity and specificity of 79.38%and 88.96%,respectively.Conclusion The predictive model of in-hospital mortality in AMICS patients constructed based on age,SBP,LVEF,Lac,BNP,D-dimer and BUN has a high predictive value for in-hospital mortality in AMICS patients.
关键词
急性心肌梗死/心源性休克/院内死亡/影响因素Key words
Acute myocardial infarction/Cardiogenic shock/In-hospital death/Influencing factors引用本文复制引用
基金项目
黑龙江省医药卫生科研课题(2019-049)
出版年
2024
NETL
NSTL
万方数据