您的位置: 首页 > 2025年8月 第56卷 第8期 > 文字全文
2023年7月 第38卷 第7期11
目录

构建基于MIMIC-IV数据库的主动脉夹层B型患者急性期死亡风险列线图预测模型:一项回顾性分析

Development of a nomogram predictive model for acute mortality risk in patients with type B aortic dissection based on the MIMIC-IV database:A retrospective analysis

来源期刊: 广州医药 | 1134-1144 发布时间:2025-09-17 收稿时间:2025/11/13 18:52:32 阅读量:37
作者:
关键词:
列线图主动脉夹层B型重症监护医学信息数据库预测模型死亡风险
nomogramtype B aortic dissectionintensive care medical information databaseprediction modelmortality risk
DOI:
10.20223/j.cnki.1000-8535.2025.08.018
收稿时间:
2024-05-17 
修订日期:
 
接收日期:
 
引用总数:
0  
目的 构建并验证主动脉夹层B型(TBAD)患者急性期预后的列线图预测模型,帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险,并制定更合适的治疗策略。方法 回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料,结局为TBAD患者急性期(≤14 d)内死亡。先采用最小绝对收缩选择算法回归筛选特征变量,再采用多因素分析确定独立预后因素,并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析(DCA)评价列线图预测模型的性能和临床适用性。结果 APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776(95% CI:0.691 ~ 0.860),Hosmer-Lemeshow 检验P=0.604,校准曲线和标准曲线高度重合,表明该模型具有良好的区分度和校准度。同时,DCA曲线显示,预测模型在大部分的阈值概率范围内提供了显著的净收益。结论 本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险,有助于临床医生制定更合适的个体化治疗策略。
Objective To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection(TBAD),enabling clinicians to more precisely evaluate mortality risk in TBAD patients during the acute stage and to devise better treatment plans.Methods This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2,focusing on mortality within 14 days of the acute phase in TBAD patients. Initially,the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection,and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model.The nomogram predictive model's effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve,calibration curve,and Decision Curve Analysis(DCA).Results Acute Physidogy Score Ⅲ score,total carbon dioxide,and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients.The internal validation of the nomogram predictive model showed an area under the curve of 0.776(95%CI:0.691-0.860),with a Hosmer-Lemeshow test P-value of 0.604. The close alignment of the calibration and standard curves suggested the model's strong discriminative power and calibration. Furthermore,the DCA curve revealed that the predictive model offered substantial net benefits within a wide range of threshold probabilities.Conclusions This study's nomogram,developed using APS Ⅲ score,total carbon dioxide,and red blood cell distribution width,accurately predicts the 14-day mortality risk in TBAD patients,assisting clinicians in creating better personalized treatment plans.
1、 YANG C H,CHEN Y A,BIN P J,et al.Associations of the erum total carbon dioxide level with long-term clinical outcomes in sepsis survivors[J].Infect Dis Ther,2023,12(2):687-701. YANG C H,CHEN Y A,BIN P J,et al.Associations of the erum total carbon dioxide level with long-term clinical outcomes in sepsis survivors[J].Infect Dis Ther,2023,12(2):687-701.
2、 KIM J H,JANG D-H,JO Y H,et al.Serum total carbon dioxide as a prognostic factor for 28-day mortality in patients with sepsis[J].Am J Emerg Med,2021(44):277-283. KIM J H,JANG D-H,JO Y H,et al.Serum total carbon dioxide as a prognostic factor for 28-day mortality in patients with sepsis[J].Am J Emerg Med,2021(44):277-283.
3、 SANGOI M,GUARDA N,R?DEL A,et al.Prognostic value of red blood cell distribution width in prediction of in-hospital mortality in patients with acute myocardial infarction[J].Clin Lab,2014,60(8):1351-1356. SANGOI M,GUARDA N,R?DEL A,et al.Prognostic value of red blood cell distribution width in prediction of in-hospital mortality in patients with acute myocardial infarction[J].Clin Lab,2014,60(8):1351-1356.
4、 LORENTE L,MARTíN M M,ABREU-GONZáLEZ P,et al.Early mortality of brain infarction patients and red blood cell distribution width[J].Brain Sci,2020,10(4):196. LORENTE L,MARTíN M M,ABREU-GONZáLEZ P,et al.Early mortality of brain infarction patients and red blood cell distribution width[J].Brain Sci,2020,10(4):196.
5、 PLUTA M,KLOCEK T,KRZYCH ? J.Trafno?? diagnostyczna wska?nika zmienno?ci rozmiaru erytrocytów w przewidywaniu zgonu szpitalnego u chorych poddawanych operacjom przewodu pokarmowego du?ego ryzyka[J].Anestezjol Intensive Ther,2018,50(4):277-282. PLUTA M,KLOCEK T,KRZYCH ? J.Trafno?? diagnostyczna wska?nika zmienno?ci rozmiaru erytrocytów w przewidywaniu zgonu szpitalnego u chorych poddawanych operacjom przewodu pokarmowego du?ego ryzyka[J].Anestezjol Intensive Ther,2018,50(4):277-282.
6、 SUN I O,CHUNG B H,YOON H J,et al.Clinical significance of red blood cell distribution width in the prediction of mortality in patients on peritoneal dialysis[J].Kidney Res Clin Pract,2016,35(2):114-118. SUN I O,CHUNG B H,YOON H J,et al.Clinical significance of red blood cell distribution width in the prediction of mortality in patients on peritoneal dialysis[J].Kidney Res Clin Pract,2016,35(2):114-118.
7、 SCHOE A,BAKHSHI-RAIEZ F,de KEIZER N,et al.Mortality prediction by SOFA score in ICU-patients after cardiac surgery;comparison with traditional prognostic-models[J].BMC Anesthesiol,2020,20(1):65. SCHOE A,BAKHSHI-RAIEZ F,de KEIZER N,et al.Mortality prediction by SOFA score in ICU-patients after cardiac surgery;comparison with traditional prognostic-models[J].BMC Anesthesiol,2020,20(1):65.
8、 PAN L N,PAN S A,LEI B H,et al.Development of a novel nomogram incorporating red blood cell distribution width-albumin ratio for the prediction of 30-day mortality in acute pancreatitis patients[J].Emerg Med Int,2022(2022):1573931. PAN L N,PAN S A,LEI B H,et al.Development of a novel nomogram incorporating red blood cell distribution width-albumin ratio for the prediction of 30-day mortality in acute pancreatitis patients[J].Emerg Med Int,2022(2022):1573931.
9、 QUINTANA J M,ESTEBAN C,UNZURRUNZAGA A,et al.Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments[J].BMC Med,2014(12):66. QUINTANA J M,ESTEBAN C,UNZURRUNZAGA A,et al.Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments[J].BMC Med,2014(12):66.
10、 LASICA R M,PERUNICIC J P,POPOVIC D R,et al.Early and late mortality predictors in patients with acute aortic dissection type B[J].Cardiol Res Pract,2022(2022):7869356. LASICA R M,PERUNICIC J P,POPOVIC D R,et al.Early and late mortality predictors in patients with acute aortic dissection type B[J].Cardiol Res Pract,2022(2022):7869356.
11、 HOWARD C,SHERIDAN J,PICCA L,et al.TEVAR for complicated anduncomplicated type B aortic dissection-Systematic review and meta-analysis[J].J Card Surg,2021,36(10):3820-3830. HOWARD C,SHERIDAN J,PICCA L,et al.TEVAR for complicated anduncomplicated type B aortic dissection-Systematic review and meta-analysis[J].J Card Surg,2021,36(10):3820-3830.
12、 XU L,DU S,JIN L.Predictive model for pulmonary embolism in pregnant and postpartum women:A 10-year retrospective study[J].Clin Appl Thromb Hemost,2023,29:10760296231209930. XU L,DU S,JIN L.Predictive model for pulmonary embolism in pregnant and postpartum women:A 10-year retrospective study[J].Clin Appl Thromb Hemost,2023,29:10760296231209930.
13、 WU H,LIAO B,JI T,et al.A nomogram for predicting in-hospital overall survival of hypertriglyceridemia-induced severe acute pancreatitis:A single center,cross-sectional study[J].Heliyon,2023,10(1):e23454. WU H,LIAO B,JI T,et al.A nomogram for predicting in-hospital overall survival of hypertriglyceridemia-induced severe acute pancreatitis:A single center,cross-sectional study[J].Heliyon,2023,10(1):e23454.
14、 陈志丹,陈德杰.甲状腺癌术后复发相关危险因素分析及复发预测模型构建[J].东南大学学报(医学版),2015,34(1):92-95. 陈志丹,陈德杰.甲状腺癌术后复发相关危险因素分析及复发预测模型构建[J].东南大学学报(医学版),2015,34(1):92-95.
15、 杨正霞,王和勇,贺施琪,等.基于随机森林算法建立甲状腺功能减退患病风险预测模型[J].广州医药,2023,54(7):16-24. 杨正霞,王和勇,贺施琪,等.基于随机森林算法建立甲状腺功能减退患病风险预测模型[J].广州医药,2023,54(7):16-24.
16、 谢恋,卢慧英,王瑞瑜,等.老年吸入性肺炎的危险因素分析及风险预测模型构建[J].广州医药,2022,53(2):12-16,22. 谢恋,卢慧英,王瑞瑜,等.老年吸入性肺炎的危险因素分析及风险预测模型构建[J].广州医药,2022,53(2):12-16,22.
17、 杨帅,于红静,何家欣,等.ICU患者再喂养综合征风险预测模型的研究进展[J].现代医院,2024,24(2):317-319,324. 杨帅,于红静,何家欣,等.ICU患者再喂养综合征风险预测模型的研究进展[J].现代医院,2024,24(2):317-319,324.
18、 ZILBER Z A,BODDU A,MALAISRIE S C,et al.Noninvasive morphologic and hemodynamic evaluation of type B aortic dissection:state of the art and future perspectives[J].Radiol Cardiothorac Imaging,2021,3(3):e200456. ZILBER Z A,BODDU A,MALAISRIE S C,et al.Noninvasive morphologic and hemodynamic evaluation of type B aortic dissection:state of the art and future perspectives[J].Radiol Cardiothorac Imaging,2021,3(3):e200456.
19、 TORRENT D J,MCFARLAND G E,WANG G,et al.Timing of thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection and the association with complications[J].J Vasc Surg,2021,73(3):826-835. TORRENT D J,MCFARLAND G E,WANG G,et al.Timing of thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection and the association with complications[J].J Vasc Surg,2021,73(3):826-835.
20、 DESAI N D,GOTTRET J P,SZETO W Y,et al.Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection[J].J Thorac Cardiovasc Surg,2015,149(2):S151-S156. DESAI N D,GOTTRET J P,SZETO W Y,et al.Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection[J].J Thorac Cardiovasc Surg,2015,149(2):S151-S156.
21、 ZHANG M H,DU X,GUO W,et al.Early and midterm outcomes of thoracic endovascular aortic repair(TEVAR)for acute and chronic complicated type B aortic dissection[J].Medicine,2017,96(28):e7183. ZHANG M H,DU X,GUO W,et al.Early and midterm outcomes of thoracic endovascular aortic repair(TEVAR)for acute and chronic complicated type B aortic dissection[J].Medicine,2017,96(28):e7183.
22、 NEWMAN J,MATTIA A,MATTIA A.Indications for thoracic EndoVascular aortic repair(TEVAR):A brief review[J].Int J Angiol,2018,27(4):177-184. NEWMAN J,MATTIA A,MATTIA A.Indications for thoracic EndoVascular aortic repair(TEVAR):A brief review[J].Int J Angiol,2018,27(4):177-184.
23、 LUEBKE T,BRUNKWALL J.Type B aortic dissection:A review of prognostic factors and meta-analysis of treatment options[J].Aorta,2014,2(6):265-278. LUEBKE T,BRUNKWALL J.Type B aortic dissection:A review of prognostic factors and meta-analysis of treatment options[J].Aorta,2014,2(6):265-278.
24、 MUNSHI B,RITTER J C,DOYLE B J,et al.Management of acute type B aortic dissection[J].ANZ J Surg,2020,90(12):2425-2433. MUNSHI B,RITTER J C,DOYLE B J,et al.Management of acute type B aortic dissection[J].ANZ J Surg,2020,90(12):2425-2433.
25、 SUZUKI T,EAGLE K A,BOSSONE E,et al.Medical management in type B aortic dissection.[J].Ann Cardiothorac Surg,2014,3(4):413-417. SUZUKI T,EAGLE K A,BOSSONE E,et al.Medical management in type B aortic dissection.[J].Ann Cardiothorac Surg,2014,3(4):413-417.
26、 HOWARD D P,BANERJEE A,FAIRHEAD J F,et al.Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control:10-year results from the Oxford Vascular Study[J].Circulation,2013,127(20):2031-2037. HOWARD D P,BANERJEE A,FAIRHEAD J F,et al.Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control:10-year results from the Oxford Vascular Study[J].Circulation,2013,127(20):2031-2037.
27、 ERBEL R,ABOYANS V,BOILEAU C,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases[J].Eur Heart J,2014,35(41):2873-2926. ERBEL R,ABOYANS V,BOILEAU C,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases[J].Eur Heart J,2014,35(41):2873-2926.
28、 HAGAN P G,NIENABER C A,ISSELBACHER E M,et al.The International Registry of Acute Aortic Dissection(IRAD)[J].JAMA,2000,283(7):897. HAGAN P G,NIENABER C A,ISSELBACHER E M,et al.The International Registry of Acute Aortic Dissection(IRAD)[J].JAMA,2000,283(7):897.
上一篇
下一篇
出版者信息








《广州医药》公众号
目录