Coleman S Y, Pritchett C J, Wong J, Branicki F J
Department of Statistics, University of Hong Kong.
Ann R Coll Surg Engl. 1991 May;73(3):179-84.
In order to better define management policies we attempted to construct risk models for rebleeding on initial conservative management and mortality after emergency surgery for failure of medical therapy in 387 patients with bleeding gastric ulcer. Several different models were constructed using logistic regression analysis with validation by the 'leaving-one-out' method. However, despite large patient numbers, modelling in this way is difficult because of inherent wide variation between patients. Suitable models for rebleeding were regarded as rather unsatisfactory, for although overall accuracy was 86%, sensitivity was only 54%. More promising was a model for mortality after emergency surgery which had an accuracy of 93% and a sensitivity of 80%. Such mortality models incorporating age, history of previous malignant disease or dyspepsia, the presence or absence of ascites and total transfusion requirements may well prove to be of value in surgical practice. This paper seeks to examine the process of modelling rebleeding and mortality and of interpreting the models produced.
为了更好地制定管理策略，我们尝试为387例出血性胃溃疡患者构建初始保守治疗时再出血及药物治疗失败后急诊手术后死亡率的风险模型。使用逻辑回归分析构建了几种不同的模型，并采用“留一法”进行验证。然而，尽管患者数量众多，但由于患者之间存在固有的广泛差异，以这种方式建模很困难。对于再出血的合适模型被认为相当不尽人意，因为尽管总体准确率为86%，但敏感性仅为54%。更有前景的是一个急诊手术后死亡率模型，其准确率为93%，敏感性为80%。这种纳入年龄、既往恶性疾病或消化不良病史、有无腹水以及总输血需求的死亡率模型很可能在外科实践中证明是有价值的。本文旨在探讨再出血和死亡率建模过程以及对所产生模型的解读。
