急诊科心力衰竭患者紧急心力衰竭死亡率风险分级风险模型的外部验证与优化

External Validation and Refinement of Emergency Heart Failure Mortality Risk Grade Risk Model in Patients With Heart Failure in the Emergency Department.

作者信息

Sepehrvand Nariman, Youngson Erik, Bakal Jeffrey A, McAlister Finlay A, Rowe Brian H, Ezekowitz Justin A

机构信息

Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

出版信息

CJC Open. 2019 Apr 12;1(3):123-130. doi: 10.1016/j.cjco.2019.03.003. eCollection 2019 May.

DOI:10.1016/j.cjco.2019.03.003

PMID:32159095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7063601/

Abstract

BACKGROUND

Emergency Heart Failure Mortality Risk Grade (EHMRG) assesses the risk of death within 7 days of emergency department (ED) presentation for patients with acute heart failure (AHF). We aimed to externally validate and refine the EHMRG model in patients who presented to the ED with AHF.

METHODS

We performed a cohort study using administrative data for all ambulance-transported patients from Alberta (2012-2016) presenting to the ED with a primary diagnosis of AHF.

RESULTS

Among 6708 patients with AHF, the 7-day mortality was 0.0%, 0.8%, 1.6%, 4.0%, 4.2%, and 12.0% across EHMRG risk categories (1-4, 5A and 5B). The EHMRG score had a c-index of 0.73 (95% confidence interval [CI], 0.71-0.76) for 7-day mortality and 0.71 (95% CI, 0.70-0.73) for 30-day mortality, but lower c-statistics for other outcomes (0.61-0.67). The inclusion of natriuretic peptides to the EHMRG model improved prediction (Net Reclassification Improvement, 0.268; 95% CI, 0.173-0.363; 0.01) for 7-day mortality, as did the addition of the Canadian Triage and Acuity Scale (Net Reclassification Improvement, 0.111; 95% CI, 0.005-0.218; 0.04).

CONCLUSION

The EHMRG model exhibited moderate discriminative ability in a large population-based cohort of patients with AHF in the ED. Revision of the EHMRG score through factor inclusion and exclusion could improve the model's performance.

摘要

背景

急诊心力衰竭死亡风险分级（EHMRG）用于评估急性心力衰竭（AHF）患者在急诊科（ED）就诊后7天内的死亡风险。我们旨在对因AHF就诊于ED的患者进行EHMRG模型的外部验证和优化。

方法

我们利用艾伯塔省（2012 - 2016年）所有经救护车转运至ED且初步诊断为AHF的患者的管理数据进行了一项队列研究。

结果

在6708例AHF患者中，按照EHMRG风险类别（1 - 4、5A和5B）划分，7天死亡率分别为0.0%、0.8%、1.6%、4.0%、4.2%和12.0%。EHMRG评分对7天死亡率的c指数为0.73（95%置信区间[CI]，0.71 - 0.76），对30天死亡率的c指数为0.71（95%CI，0.70 - 0.73），但对其他结局的c统计量较低（0.61 - 0.67）。将利钠肽纳入EHMRG模型可改善对7天死亡率的预测（净重新分类改善，0.268；95%CI，0.173 - 0.363；P = 0.01），加入加拿大分诊及 acuity 量表后也是如此（净重新分类改善，0.111；95%CI，0.005 - 0.218；P = 0.04）。