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根据国家数据库,预测癫痫持续状态死亡率的风险评分。

Risk score predictive of mortality in status epilepticus according to a national database.

机构信息

Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.

出版信息

Epilepsia. 2018 Oct;59 Suppl 2:182-187. doi: 10.1111/epi.14489. Epub 2018 Aug 29.

Abstract

Status epilepticus (SE) is a serious neurologic condition with high morbidity and mortality rates. This study aimed to develop and validate a risk score that is predictive of mortality in patients with SE using clinical factors without electrocardiography. The inclusion criteria of this study were all patients diagnosed with SE and treated between 2005 and 2015. We retrospectively searched for eligible patients using the International Classification of Diseases, Tenth Revision (ICD-10) code for SE (G41) in the national Universal Health Coverage database. The outcome was death at discharge or within 30 days after discharge. Factors-associated death was analyzed using stepwise logistic regression analysis. Risk scores were developed based on the final logistic regression model. The final model was also validated. There were 10 924 patients used for model development and 10 808 used for model validation. The formula to determine the risk score for SE mortality was 5 × shock + 4 × age over 60 years old + 3.5 × heart diseases + 3 × acute renal failure + 3 × septicemia + 2.5 × central nervous system infection + 2.5 × age 41-60 years old + 2 × cancer + 2 × chronic renal failure + 1.5 × age 21-40 years old + 1 × pneumonia + 1 × respiratory failure + 1 × anemia. The risk scores of greater than 4 indicated risk for mortality with a sensitivity of 78.20% and specificity of 75.38%. The area under the receiver-operating characteristic (ROC) curve for death in the final model was 83.59%. The area under the ROC curve for the model validation group was 83.52%. SE patients who had a risk score of 4 or more were at high risk for death. Physicians should be aware of the high mortality rate in these particular patients.

摘要

癫痫持续状态(SE)是一种严重的神经系统疾病,发病率和死亡率都很高。本研究旨在开发和验证一种使用不包括心电图的临床因素预测 SE 患者死亡率的风险评分。本研究的纳入标准为 2005 年至 2015 年间诊断为 SE 并接受治疗的所有患者。我们使用国家全民健康覆盖数据库中的 SE(G41)国际疾病分类,第十次修订版(ICD-10)代码进行回顾性搜索,以寻找符合条件的患者。结局是出院时或出院后 30 天内死亡。使用逐步逻辑回归分析分析与死亡相关的因素。基于最终逻辑回归模型开发风险评分。最后还对模型进行了验证。有 10924 例患者用于模型开发,10808 例患者用于模型验证。SE 死亡率风险评分的公式为:5×休克+4×年龄大于 60 岁+3.5×心脏病+3×急性肾衰竭+3×败血症+2.5×中枢神经系统感染+2.5×年龄 41-60 岁+2×癌症+2×慢性肾衰竭+1.5×年龄 21-40 岁+1×肺炎+1×呼吸衰竭+1×贫血。评分大于 4 分提示死亡率风险较高,敏感性为 78.20%,特异性为 75.38%。最终模型中死亡的受试者工作特征(ROC)曲线下面积为 83.59%。验证组模型的 ROC 曲线下面积为 83.52%。评分 4 分或以上的 SE 患者死亡风险较高。医生应该意识到这些特定患者的高死亡率。

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