Clinical risk score for postoperative pneumonia following heart valve surgery.
Clinical risk score for postoperative pneumonia following heart valve surgery.
复制标题
心脏瓣膜手术后肺炎的临床风险评分
DOI：
10.1097/cm9.0000000000001715
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发表时间：
2021-09-15
影响因子：
6.1
通讯作者：
Du XL
中科院分区：
文献类型：
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作者：
Wang DS;Huang XF;Wang HF;Le S;Du XL
摘要背景：术后肺炎(POP)是心脏瓣膜手术(HVS)后最常见的感染之一，与发病率、死亡率和医疗费用显著增加有关。这项研究的目的是确定与HVS后POP发生相关的主要危险因素，并得出并验证临床风险评分。方法：2016年1月至2019年12月在一家机构接受开放式HVS的成年人参加了这项研究。患者按1：1的比例随机分配到派生和验证集。用多元Logistic回归分析建立了预测模型。根据其回归系数，将积分分配给独立的风险因素。结果：3853例患者中有316例发生POP，发生率为8.2%。多变量分析确定了派生集中10个有意义的预测因素，包括年龄大、吸烟史、慢性阻塞性肺疾病、糖尿病、肾功能不全、心功能不佳、心脏手术史、较长的体外循环时间、输血以及同期的冠状动脉和/或主动脉手术。然后，基于多变量模型生成了22点风险评分，显示出良好的区分性(C-统计量：0.81)和校正(Hosmer-Lemeshow2χ2 = 8.234，P = 0.312)。预测规则在验证集中也显示出足够的判别能力(C-统计量：0.83)和校正(Hosmer-Lemeshow2χ2 = 5.606，P = 0.691)。三个风险区间被定义为低、中、高风险组。结论：我们得出并验证了人类免疫缺陷综合征后POP的22分风险评分，这可能在预防干预和风险管理中有用。试用注册：chictr.org，ChiCTR1900028127；http://www.chictr.org.cn/showproj.aspx?proj=46932
Abstract Background: Postoperative pneumonia (POP) is one of the most common infections following heart valve surgery (HVS) and is associated with a significant increase in morbidity, mortality, and health care costs. This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score. Methods: Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study. Patients were randomly assigned to the derivation and validation sets at 1:1 ratio. A prediction model was developed with multivariable logistic regression analysis in the derivation set. Points were assigned to independent risk factors based on their regression coefficients. Results: POP occurred in 316 of the 3853 patients (8.2%). Multivariable analysis identified ten significant predictors for POP in the derivation set, including older age, smoking history, chronic obstructive pulmonary disease, diabetes mellitus, renal insufficiency, poor cardiac function, heart surgery history, longer cardiopulmonary bypass, blood transfusion, and concomitant coronary and/or aortic surgery. A 22-point risk score based on the multivariable model was then generated, demonstrating good discrimination (C-statistic: 0.81), and calibration (Hosmer-Lemeshow χ2 = 8.234, P = 0.312). The prediction rule also showed adequate discriminative power (C-statistic: 0.83) and calibration (Hosmer-Lemeshow χ2 = 5.606, P = 0.691) in the validation set. Three risk intervals were defined as low-, medium-, and high-risk groups. Conclusion: We derived and validated a 22-point risk score for POP following HVS, which may be useful in preventive interventions and risk management. Trial Registration: Chictr.org, ChiCTR1900028127; http://www.chictr.org.cn/showproj.aspx?proj=46932