摘要
目的:研究急性主动脉夹层(AAD)保守治疗院内死亡危险因素,构建死亡风险预测模型。方法:回顾性收集2019年1月-2020年12月于济宁医学院附属医院确诊的药物保守治疗的AAD患者资料,按照住院期间是否死亡将患者分为存活组和死亡组,比较两组一般情况及相关的化验检查等指标,将两组间差异有统计学意义的研究指标纳入多因素logistic回归分析,并建立死亡风险预测模型;采用受试者工作特征曲线(ROC)分析最终纳入预测模型的研究指标对患者预后的判断性能。结果:共纳入87例患者,住院期间死亡共38例,死亡率43.69%。多因素分析显示,累及分支血管数量、假腔范围、升主动脉到主动脉弓段受累均是AAD患者保守治疗院内死亡的独立危险因素(P<0.05);评估患者院内死亡模型公式为logP=-6.698+0.749×累及分支血管数量+1.437×假腔范围+2.748×升主动脉到主动脉弓段受累。采用Homser-Lemeshow进行拟合优度检验,表明该模型可以很好地拟合(χ^(2)=2.325,P=0.940)。ROC曲线分析显示,曲线下面积为0.924(P<0.01),敏感度为76.92%,特异度为90.70%。结论:累及分支血管数量、假腔范围、升主动脉到主动脉弓段受累均是保守治疗AAD患者院内死亡的独立危险因素;构建的院内死亡风险预测模型,可用于预测AAD患者的预后。
Objective:To study risk factors for in-hospital mortality in conservative treatment of patients with acute aortic dissection(AAD)and set up a risk prediction model.Method:A retrospective analysis was performed on the clinical data from conservative treatment of patients with AAD who hospitalized in Affiliated Hospital of Jining Medical University from January 2019 to December 2020.The patients were divided into survival group and non-survival group based on whether nosocomial death occurred,and the general situation,related laboratory tests and other indicators of the two groups were compared.Binary logistic regression analysis was conducted on the factors with statistically significant difference analyzed in univariate analysis,and death prediction model was set up subsequently.For parameters in prediction model after variable screening,receiver operating characteristic curve(ROC)was applied to evaluate the predictive effect of death.Result:A total of 87 patients were enrolled,38 patients died in hospital with the mortality of 43.69%.Multivariate analysis showed that the number of branch vessels involved,tearing false lumen range and the involvement of ascending aorta to aortic arch were independent risk factors for hospitalized death in conservative treatment of patients with AAD(P<0.05).The formula for evaluating the hospitalized death model of patients was logP=-6.698+0.749×the number of branch vessels involved+1.437×tearing false lumen range+2.748×the involvement of ascending aorta to aortic arch.According to the statistics of Homser-Lemeshow,the effect of this model was good(χ^(2)=2.325,P=0.940).The analysis of ROC showed that the area under the curve was 0.924(P<0.01),the sensitivity was 76.92%,the specificity was 90.70%.Conclusion:The number of branch vessels involved,tearing false lumen range and the involvement of ascending aorta to aortic arch are independent risk factors for hospitalized death in conservative treatment of patients with AAD,the hospital mortality risk prediction model can be used to predict the prognosis of AAD patients.
作者
肖子亚
王新艳
耿加兴
张亚斌
高磊
师猛
李勇
XIAO Ziya;WANG Xinyan;GENG Jiaxing;ZHANG Yabin;GAO Lei;SHI Meng;LI Yong(Affiliated Hospital of Jining Medical University,Jining 272029,China;不详)
出处
《中国医学创新》
CAS
2022年第19期117-122,共6页
Medical Innovation of China
基金
山东省医药卫生科技发展计划资助项目(202010000964)。
关键词
急性主动脉夹层
危险因素
预测模型
Acute aortic dissection
Risk factors
Prediction model
