Sex differences in crude mortality rates and predictive value of intensive care unit-based scores when applied to the cardiac intensive care unit.
Sex differences in crude mortality rates and predictive value of intensive care unit-based scores when applied to the cardiac intensive care unit.
复制标题
DOI：
10.1177/2048872619872129
复制
发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Goldfarb M
中科院分区：
文献类型：
--
作者：
Herscovici R;Mirocha J;Salomon J;Merz NB;Cercek B;Goldfarb M
当基于重症监护病房的评分系统应用于心脏重症监护病房患者时，关于结果和预测准确性的性别差异的数据有限。我们回顾了2011年1月1日至2016年12月31日入住心脏重症监护病房的患者的病历。分析了死亡率的性别差异以及基于重症监护病房的评分系统在预测院内死亡率方面的表现。通过 Hosmer-Lemeshow 检验和局部加权散点图平滑曲线评估校准。使用 c 统计量和接受者操作特征曲线来评估歧视。在 6963 名患者中，2713 名 (39%) 是女性。女性和男性的院内和心脏重症监护病房总体死亡率相似（分别为 9.1% vs 9.4%，p=0.67 和 5.9% vs 6%，p=0.88）以及年龄和主要诊断亚组。在评分系统中，急性生理学和慢性健康评估 III 以及序贯器官衰竭评估的校准较差（Hosmer-Lemeshow p 值<0.001），而简化急性生理学评分 II 在女性和男性中表现较好（Hosmer-Lemeshow p 值 0.09）。所有分数均具有良好的区分度（C 统计>0.8）。在急性心肌梗死和心力衰竭患者亚组中，所有评分均具有良好的校准（Hosmer-Lemeshow p>0.001）和区分度（C 统计量 >0.8），而在死亡率最高的诊断亚组中，校准因评分和性别而异，区分度较差。心脏重症监护室患者的死亡率没有性别差异。基于重症监护室的评分的死亡率预测价值在男女中都是有限的，并且在不同的诊断亚组之间存在差异。
Limited data exists regarding sex differences in outcome and predictive accuracy of intensive care unit-based scoring systems when applied to cardiac intensive care unit patients. We reviewed medical records of patients admitted to cardiac intensive care unit from 1 January 2011–31 December 2016. Sex differences in mortality rates and the performance of intensive care unit-based scoring systems in predicting in-hospital mortality were analyzed. Calibration was assessed by the Hosmer-Lemeshow test and locally weighted scatterplot smoothing curves. Discrimination was assessed using the c statistic and receiver-operating characteristic curve. Among 6963 patients, 2713 (39%) were women. Overall in-hospital and cardiac intensive care unit mortality rates were similar in women and men (9.1% vs 9.4%, p=0.67 and 5.9% vs 6%, p=0.88, respectively) and in age and major diagnosis subgroups. Of the scoring systems, Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment had poor calibration (Hosmer-Lemeshow p value <0.001), while Simplified Acute Physiology Score II performed better (Hosmer-Lemeshow p value 0.09), in both women and men. All scores had good discrimination (C statistics >0.8). In the subgroups of acute myocardial infarction and heart failure patients, all scores had good calibration (Hosmer-Lemeshow p>0.001) and discrimination (C statistic >0.8) while in diagnosis subgroups with highest mortality, the calibration varied among scores and by sex, and discrimination was poor. No sex differences in mortality were seen in cardiac intensive care unit patients. The mortality predictive value of intensive care unit-based scores is limited in both sexes and variable among different subgroups of diagnoses.