腹主动脉瘤破裂患者30天死亡率的术前预测因素评估
Evaluation of Preoperative Predictors of 30-Day Mortality in Patients with Ruptured Abdominal Aortic Aneurysm.
作者信息
Jang Ha Nee, Park Hyun Oh, Yang Jun Ho, Yang Tae Won, Byun Joung Hun, Moon Seong Ho, Kim Sung Hwan, Kim Jong Woo, Lee Chung Eun
机构信息
Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang Nationtal University School of Medicine, Jinju, Korea.
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang Nationtal University School of Medicine, Changwon, Korea.
出版信息
Vasc Specialist Int. 2017 Sep;33(3):93-98. doi: 10.5758/vsi.2017.33.3.93. Epub 2017 Sep 30.
PURPOSE
Ruptured abdominal aortic aneurysm (RAAA) is a rare, extremely dangerous condition. Previous studies have published preoperative, intraoperative, and postoperative data; however, there are not enough studies on the preoperative factors alone. Here we studied the preoperative predictors of 30-day mortality in patients with RAAA.
MATERIALS AND METHODS
We conducted a retrospective, consecutive review of the medical records of 57 patients who received management for RAAA between February 2005 and December 2016. We analyzed the association between preoperative predictors and 30-day mortality in patients with RAAA. The initial systolic blood pressure (SBP) and hemoglobin level (HbL), which were proven as significant predictors by multivariate logistic regression analysis, were compared using receiver operating characteristic curves.
RESULTS
Overall, early mortality was 29.8%. Results of logistic regression analysis found that 30-day mortality in patients with RAAA was associated with the initial SBP (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.874-0.973; P=0.003) and initial HbL (OR, 0.513; 95% CI, 0.289-0.91; P=0.023). Area under the curves were 0.89 for the initial SBP and 0.78 for the initial HbL. The initial SBP with a cut-off value of 90 mmHg had a sensitivity of 85% and specificity of 88.2%. At a cut-off of 10.5, the sensitivity and specificity of HbL for death were 75% and 70.6%, respectively.
CONCLUSION
The initial SBP and HbL are independent preoperative predictors of early mortality in patients with RAAA.
目的
腹主动脉瘤破裂（RAAA）是一种罕见且极其危险的病症。既往研究已发表术前、术中和术后数据；然而，仅关于术前因素的研究并不充分。在此，我们研究了RAAA患者30天死亡率的术前预测因素。
材料与方法
我们对2005年2月至2016年12月期间接受RAAA治疗的57例患者的病历进行了回顾性、连续性分析。我们分析了RAAA患者术前预测因素与30天死亡率之间的关联。通过多因素逻辑回归分析被证明为显著预测因素的初始收缩压（SBP）和血红蛋白水平（HbL），使用受试者工作特征曲线进行比较。
结果
总体而言，早期死亡率为29.8%。逻辑回归分析结果发现，RAAA患者的30天死亡率与初始SBP（比值比[OR]，0.922；95%置信区间[CI]，0.874 - 0.973；P = 0.003）和初始HbL（OR，0.513；95% CI，0.289 - 0.91；P = 0.023）相关。初始SBP的曲线下面积为0.89，初始HbL的曲线下面积为0.78。初始SBP的临界值为90 mmHg时，敏感性为85%，特异性为88.2%。HbL对于死亡的临界值为10.5时，敏感性和特异性分别为75%和70.6%。
结论
初始SBP和HbL是RAAA患者早期死亡率的独立术前预测因素。
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