Mortality prediction following non-traumatic amputation of the lower extremity
Mortality prediction following non-traumatic amputation of the lower extremity
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DOI：
10.1002/bjs.11124
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发表时间：
2019-06-01
影响因子：
9.6
通讯作者：
Czerniecki, J. M.
中科院分区：
文献类型：
--
作者：
Norvell, D. C.;Thompson, M. L.;Czerniecki, J. M.
背景资料：因糖尿病或外周动脉疾病并发症而进行下肢截肢的患者，其长期生存率很低。为患者和外科医生提供个体患者，而不是人口，生存估计为他们提供了重要的信息，使个性化的治疗decisions.Methods：外周动脉疾病和/或糖尿病患者进行首次单侧transmetatarsal，transtibial或transfemoral截肢被确定在退伍军人事务部手术质量改进计划（VASQIP）数据库。逐步下降逻辑回归被用来开发一个1年死亡风险预测模型，从33个候选预测因子的列表中使用的数据从五个退伍军人事务部国家地理区域。使用其余两个区域的数据进行外部地理验证。结果：开发样本包括5028例患者，验证样本包括2140例患者。最终死亡率预测模型（AMPREDICT-Mortality）包括截肢程度、年龄、BMI、种族、功能状态、充血性心力衰竭、透析、血尿素氮水平、白细胞和血小板计数。验证样本中的模型拟合良好。验证样本的受试者工作特征（ROC）曲线下面积为0.76，考克斯校准回归表明校准效果良好（斜率为0.96，95% c. I. 0.85到1.06;截距0.02，95% c. I. -0.12到0.17）。考虑到外部验证的特点，将开发和验证样本合并，总样本数为7168。结论：AMPREDICT-Mortality预测模型是一个经过验证的简约模型，可用于预测外周动脉疾病或糖尿病患者非创伤性下肢截肢后1年的死亡风险。
Background: Patients who undergo lower extremity amputation secondary to the complications of diabetes or peripheral artery disease have poor .term survival. Providing patients and surgeons with individual-patient, rather than population, survival estimates provides them with important information to make individualized treatment decisions.Methods: Patients with peripheral artery disease and/or diabetes undergoing their first unilateral transmetatarsal, transtibial or transfemoral amputation were identified in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Stepdown logistic regression was used to develop a 1-year mortality risk prediction model from a list of 33 candidate predictors using data from three of five Department of Veterans Affairs national geographical regions. External geographical validation was performed using data from the remaining two regions. Calibration and discrimination were assessed in the development and validation samples.Results: The development sample included 5028 patients and the validation sample 2140. The finalmortality prediction model (AMPREDICT-Mortality) included amputation level, age, BMI, race, functional status, congestive heart failure, dialysis, blood urea nitrogen level, andwhite blood cell and platelet counts. The model fit in the validation sample was good. The area under the receiver operating characteristic (ROC) curve for the validation sample was 0.76 and Cox calibration regression indicated excellent calibration (slope 0.96, 95 per cent c. i. 0.85 to 1.06; intercept 0.02, 95 per cent c. i. -0.12 to 0.17). Given the external validation characteristics, the development and validation samples were combined, giving a total sample of 7168.Conclusion: The AMPREDICT-Mortality prediction model is a validated parsimonious model that can be used to inform the 1-year mortality risk following non-traumatic lower extremity amputation of patients with peripheral artery disease or diabetes.