Derivation and validation of a prognostic model for pulmonary embolism
Derivation and validation of a prognostic model for pulmonary embolism
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DOI：
10.1164/rccm.200506-862oc
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发表时间：
2005-10-15
影响因子：
24.7
通讯作者：
Fine, MJ
中科院分区：
文献类型：
--
作者：
Aujesky, D;Obrosky, DS;Fine, MJ
基本原理：肺栓塞患者的客观和简单的预后模型可能有助于指导初始intensityoftreatment.Objectives：制定一个临床预测规则，准确地将肺栓塞患者分为死亡率和其他不良医疗outcome.Methods：增加风险的类别：我们随机分配了15,531例住院肺栓塞出院从宾夕法尼亚州186家医院的衍生（67%）和内部验证（33%）样本。我们使用逻辑回归得出我们的预测规则，以30天死亡率作为主要结局，患者人口统计学和临床数据作为潜在的预测变量。我们在瑞士和法国的221名肺栓塞住院患者中对该规则进行了外部验证。测量：我们比较了推导样本和两个验证样本的死亡率和非致命性不良医疗结果。主要结果：该预测规则基于11个与死亡率独立相关的简单患者特征，并将肺栓塞患者分为5个严重等级，在衍生和验证样本中，I类30天死亡率为0 - 1.6%，II类为1.7 - 3.5%，III类为3.2 - 7.1%，IV类为4.0 - 11.4%，V类为10.0 - 24.5%。住院死亡和非致命性并发症是
Rationale: An objective and simple prognostic model for patients with pulmonary embolism could be helpful in guiding initial intensity of treatment.Objectives:To develop a clinical prediction rule that accurately classifies patients with pulmonary embolism into categories of increasing risk of mortality and other adverse medical outcomes.Methods: We randomly allocated 15,531 inpatient discharges with pulmonary embolism from 186 Pennsylvania hospitals to derivation (67%) and internal validation (33%) samples. We derived our prediction rule using logistic regression with 30-day mortality as the primary outcome, and patient demographic and clinical data routinely available at presentation as potential predictor variables. We externally validated the rule in 221 inpatients with pulmonary embolism from Switzerland and France.Measurements: We compared mortality and nonfatal adverse medical outcomes across the derivation and two validation samples.Main Results: The prediction rule is based on 11 simple patient characteristics that were independently associated with mortality and stratifies patients with pulmonary embolism into five severity classes, with 30-day mortality rates of 0-1.6% in class I, 1.7-3.5% in class II, 3.2-7.1% in class III, 4.0-11.4% in class IV, and 10.0-24.5% in class V across the derivation and validation samples. Inpatient death and nonfatal complications were