摘要
目的外部验证IABP-ShockⅡ(intra-aortic balloon pumping in acute myocardial infarction complicated by cardiogenic shock)评分及CardShock评分预测急性心肌梗死合并心源性休克患者院内死亡风险的准确性,并与急性生理学-慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分进行比较。方法根据纳入标准及排除标准回顾性纳入2010年12月至2019年5月于北京朝阳医院心脏中心住院治疗的急性心肌梗死合并心源性休克患者。收集患者基本特点资料,并将患者按照院内存活情况分为存活组及死亡组。APACHEⅡ评分为患者住院期间评分,研究者回顾性收集。IABP-ShockⅡ评分与CardShock评分由两位研究者独立进行评分,分歧与第三位研究者讨论解决。从区分度和校准度两个方面验证与比较评分预测的准确性。使用受试者操作曲线(the receiver operating characteristic curve,ROC curve)描述评分的区分度,使用Delong法比较区分度。使用Hosmer-Lemeshow拟合优度检验及校准曲线验证及比较评分校准度。结果共纳入急性心肌梗死合并心源性休克患者150例,院内病死率为60%。IABP-ShockⅡ评分属于低风险(0~2分)、中等风险(3~4分)及高风险(5~9)的病死率依次为29%、68%、80%。CardShock评分属于低风险(0~3分)中等风险的(4~5分)及高风险(6~9分)的病死率依次为21%、57%、82%。APACHEⅡ评分<20分、20~30分及>30分的病死率依次为19%、69%、93%。对于院内死亡事件的预测,APACHEⅡ评分显示出优异的区分度(AUC=0.90,95%CI:0.84~0.94),而IABP-ShockⅡ评分与CardShock评分显示出良好的区分度(AUC=0.76,95%CI:0.68~0.83和AUC=0.79,95%CI:0.72~0.85)。在评分的比较中,IABP-ShockⅡ评分及CardShock评分的区分度比较差异无统计学意义(0.76 vs 0.79,P>0.05),但均显著低于APACHEⅡ评分(0.76 vs 0.90,P<0.05和0.79 vs 0.90,P<0.05)。根据Hosmer-Lemeshow拟合优度检验,所有评分均获得充分的校准(P>0.0
Objective To externally validated the intra-aortic balloon pump(IABP)shockⅡscore and CardShock score for predicting in-hospital mortality in patients with acute myocardial infarction complicated by cardiogenic shock(AMI-CS)and compared them with the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score.Methods According to the inclusion and exclusion criteria,patients admitted to the cardiac care center(CCU)of our center from December 2010 to May 2019 were enrolled in this study.Patients'baseline characteristics,in-hospital interventions,and outcomes were collected.The APACHEⅡscore was calculated during hospitalization by clinicians and collected by researchers.Two researchers independently calculated the IABP-ShockⅡscore and CardShock score;any disagreement was discussed with the third researcher.The performance of risk scores was evaluated by discrimination and calibration.The discriminative ability of risk scores was evaluated using the area under the receiver operating characteristic curve(AUC)and compared by the Delong method.The calibration of these risk scores was examined by the Hosmer-Lemeshow goodness-of-fit test.The calibration plot was also built.Results A total of 150 patients enrolled in our study,and the in-hospital mortality was 60%.According to the IABP-ShockⅡscore,patients scored as low risk(0-2),moderate risk(3-4),and high risk(5-9)had in-hospital mortality of 29%,68%,and 80%,respectively.According to the CardShock score,patients scored as low risk(0-3),moderate risk(4-5),and high risk(6-9)had in-hospital mortality of 21%,57%,and 82%,respectively.According to the APACHEⅡscore,patients scored<20,20-30,and>30 had in-hospital mortality of 19%,69%,and 93%,respectively.For predicting the in-hospital mortality,the APACHEⅡscore demonstrated excellent discrimination(AUC=0.90,95%CI:0.84-0.95).The IABP-ShockⅡscore and CardShock score showed good discrimination(AUC=0.76,95%CI:0.68-0.83 and AUC=0.79,95%CI:0.72-0.85).The discriminative ability did not significantly differ between t
作者
丰德京
刘宇
王乐丰
杨新春
杜胜利
李闯
翟真
李彦彦
Feng Dejing;Liu Yu;Wang Lefeng;Yang Xinchun;Du Shengli;Li Chuang;Zhai Zhen;Li Yanyan(Department of Cardiology,Beijing Chaoyang Hospital,Capital Medical university,Beijing 100020,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第7期914-920,共7页
Chinese Journal of Emergency Medicine
基金
国家重点研发计划资助(2016YFC1301100)
北京市医院管理中心消化内科学科协同发展中心消化专项重点项目子课题(XXZ0607)。
