Krämer Sebastian, Broschewitz Johannes, Kirsten Holger, Sell Carolin, Eichfeld Uwe, Struck Manuel Florian
Division of Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany.
Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
J Clin Med. 2020 Feb 1;9(2):382. doi: 10.3390/jcm9020382.
Iatrogenic tracheal ruptures are rare but severe complications of medical interventions. The main goal of this study was to explore prognostic factors for all-cause mortality and rupture-related (adjusted) mortality. We retrospectively analyzed patients admitted to an academic referral center over a 15-year period (2004-2018). Fifty-four patients met the inclusion criteria, of whom 36 patients underwent surgical repair and 18 patients were treated conservatively. In a 90-day follow-up, the all-cause mortality was 50%, while the adjusted mortality was 13%. Rupture length was identified as a predictor for all-cause mortality (area under the curve, 0.84; 95% confidence interval (CI) 0.74-0.94) with a cutoff rupture length of 4.5 cm (sensitivity, 0.70; specificity, 0.81). Multivariate analysis confirmed rupture length as a prognostic factor for all-cause mortality (adjusted hazard ratio (HR) 1.5; 95% CI 1.2-1.9; = 0.001), but not for adjusted mortality (HR 1.5; 95% CI 0.97-2.3; = 0.068), while mediastinitis predicted adjusted mortality (HR 5.8; 95% CI 1.1-31.7; = 0.042), but not all-cause mortality (HR 1.6; 95% CI 0.7-3.5; = 0.243). The extent of iatrogenic tracheal rupture and mediastinitis might be relevant prognostic factors for all-cause mortality and adjusted mortality, respectively.
医源性气管破裂虽罕见，但却是医疗干预的严重并发症。本研究的主要目的是探讨全因死亡率和破裂相关（校正后）死亡率的预后因素。我们回顾性分析了一家学术转诊中心15年期间（2004 - 2018年）收治的患者。54例患者符合纳入标准，其中36例患者接受了手术修复，18例患者接受了保守治疗。在90天的随访中，全因死亡率为50%，而校正后死亡率为13%。破裂长度被确定为全因死亡率的预测因素（曲线下面积，0.84；95%置信区间（CI）0.74 - 0.94），临界破裂长度为4.5 cm（敏感性，0.70；特异性，0.81）。多因素分析证实破裂长度是全因死亡率的预后因素（校正风险比（HR）1.5；95% CI 1.2 - 1.9；P = 0.001），但不是校正后死亡率的预后因素（HR 1.5；95% CI 0.97 - 2.3；P = 0.068），而纵隔炎可预测校正后死亡率（HR 5.8；95% CI 1.1 - 31.7；P = 0.042），但不是全因死亡率（HR 1.6；95% CI 0.7 - 3.5；P = 0.243）。医源性气管破裂的程度和纵隔炎可能分别是全因死亡率和校正后死亡率的相关预后因素。
