体外膜肺氧合治疗急性呼吸窘迫综合征患者的死亡率预测模型比较及新型预测评分的建立：体外膜肺氧合治疗存活预测评分（PRESET 评分）。
Comparison of mortality prediction models in acute respiratory distress syndrome undergoing extracorporeal membrane oxygenation and development of a novel prediction score: the PREdiction of Survival on ECMO Therapy-Score (PRESET-Score).
机构信息
Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, and Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany.
Klinik für Anästhesiologie und Intensivmedizin, Marienhospital Osnabrück, Osnabrück, Germany.
出版信息
Crit Care. 2017 Dec 12;21(1):301. doi: 10.1186/s13054-017-1888-6.
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy in acute respiratory distress syndrome (ARDS) patients but is associated with complications and costs. Here, we validate various scores supposed to predict mortality and develop an optimized categorical model.
METHODS
In a derivation cohort, 108 ARDS patients (2010-2015) on veno-venous ECMO were retrospectively analysed to assess four established risk scores (ECMOnet-Score, RESP-Score, PRESERVE-Score, Roch-Score) for mortality prediction (receiver operating characteristic analysis) and to identify by multivariable logistic regression analysis independent variables for mortality to yield the new PRESET-Score (PREdiction of Survival on ECMO Therapy-Score). This new score was then validated both in independent internal (n = 82) and external (n = 59) cohorts.
RESULTS
The median (25%; 75% quartile) Sequential Organ Failure Assessment score was 14 (12; 16), Simplified Acute Physiology Score II was 62.5 (57; 72.8), median intensive care unit stay was 17 days (range 1-124), and mortality was 62%. Only the ECMOnet-Score (area under curve (AUC) 0.69) and the RESP-Score (AUC 0.64) discriminated survivors and non-survivors. Admission pH, mean arterial pressure, lactate, platelet concentrations, and pre-ECMO hospital stay were independent predictors of death and were used to build the PRESET-Score. The score's internal (AUC 0.845; 95% CI 0.76-0.93; p < 0.001) and external (AUC 0.70; 95% CI 0.56-0.84; p = 0.008) validation revealed excellent discrimination.
CONCLUSIONS
While our data confirm that both the ECMOnet-Score and the RESP-Score predict mortality in ECMO-treated ARDS patients, we propose a novel model also incorporating extrapulmonary variables, the PRESET-Score. This score predicts mortality much better than previous scores and therefore is a more precise choice for decision support in ARDS patients to be placed on ECMO.
背景
体外膜肺氧合（ECMO）是急性呼吸窘迫综合征（ARDS）患者的救命疗法，但与并发症和成本有关。在这里，我们验证了各种假设用于预测死亡率的评分，并开发了一个优化的分类模型。
方法
在一个推导队列中，回顾性分析了 108 名接受静脉-静脉 ECMO 的 ARDS 患者（2010-2015 年），以评估四个已建立的风险评分（ECMOnet-Score、RESP-Score、PRESERVE-Score、Roch-Score）对死亡率的预测（接受者操作特征分析），并通过多变量逻辑回归分析确定死亡率的独立变量，得出新的 PRESET-Score（ECMO 治疗生存预测评分）。然后，在独立的内部（n=82）和外部（n=59）队列中验证该新评分。
结果
中位（25%；75%四分位数）序贯器官衰竭评估评分 14（12；16），简化急性生理学评分 II 为 62.5（57；72.8），中位重症监护病房住院时间为 17 天（范围 1-124 天），死亡率为 62%。只有 ECMOnet-Score（曲线下面积（AUC）0.69）和 RESP-Score（AUC 0.64）区分了幸存者和非幸存者。入院时 pH 值、平均动脉压、乳酸、血小板浓度和 ECMO 前住院时间是死亡的独立预测因素，并用于构建 PRESET-Score。该评分的内部（AUC 0.845；95%CI 0.76-0.93；p<0.001）和外部（AUC 0.70；95%CI 0.56-0.84；p=0.008）验证显示出优异的区分度。
结论
虽然我们的数据证实，ECMOnet-Score 和 RESP-Score 都可以预测 ECMO 治疗的 ARDS 患者的死亡率，但我们提出了一种新的模型，该模型还结合了肺外变量，即 PRESET-Score。该评分预测死亡率的准确性远高于以前的评分，因此是在 ARDS 患者中进行 ECMO 治疗时用于决策支持的更精确选择。
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