Janssen Douglas P B, Noyez Luc, Wouters Constantijn, Brouwer Rene M H J
Department of Thoracic and Cardiac Surgery, Free University Medical Center, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands.
Eur J Cardiothorac Surg. 2004 Feb;25(2):203-7. doi: 10.1016/j.ejcts.2003.11.005.
To construct a predictive model for a prolonged stay in the intensive care unit (ICU) for coronary artery bypass graft surgery (CABG).
Eight hundred and eighty-eight patients undergoing CABG were studied by univariate and multivariate analysis. Prolonged stay in the ICU was defined as >/=3 days stay. Stepwise selective procedure (P</=0.05) was used to identify a subset of variables with prognostic value for prolonged stay. This subset was used to calculate a prognostic score S and predicted probability P (P=1/1+e(-S)). Sensitivity analysis was used for evaluation.
Significant risk factors for prolonged stay in the ICU were: lung disease, no-sinus rhythm, no-mild valve pathology, reoperation, no-elective operation, and no-off-pump procedure. The receiver operating characteristic curve gave an area under the curve value of 0.68 for prolonged stay in ICU. Observed probabilities compared well with the predicted probabilities. Patients were classified into low (5%), intermediate (15%), high (30%), and very high-risk groups (40%). A predicted probability of >/=0.40 was used as cut-off point for the prognostic test. The specificity of this test for prolonged stay in the ICU was 99%; sensitivity 9%; positive predictive value 60%; and negative predictive value 89%.
The results show that individual patients presented for CABG, can be stratified according to their risk for prolonged stay >/=3 days in the ICU.
构建冠状动脉搭桥手术（CABG）患者在重症监护病房（ICU）延长住院时间的预测模型。
采用单因素和多因素分析对888例行CABG的患者进行研究。ICU延长住院时间定义为住院≥3天。采用逐步选择法（P≤0.05）确定对延长住院时间有预后价值的变量子集。该子集用于计算预后评分S和预测概率P（P = 1/1 + e^(-S)）。采用敏感性分析进行评估。
ICU延长住院时间的显著危险因素为：肺部疾病、非窦性心律、无轻度瓣膜病变、再次手术、非择期手术和非体外循环手术。ICU延长住院时间的受试者工作特征曲线下面积值为0.68。观察到的概率与预测概率比较吻合。患者被分为低风险组（5%）、中风险组（15%）、高风险组（30%）和极高风险组（40%）。将预测概率≥0.40用作预后试验的截断点。该试验对ICU延长住院时间的特异性为99%；敏感性为9%；阳性预测值为60%；阴性预测值为89%。
结果表明，对于行CABG的个体患者，可根据其在ICU延长住院≥3天的风险进行分层。
