Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada; Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada.
Ottawa Hospital Research Institute, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Canada; Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada; School of Epidemiology,Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada.
J Cardiothorac Vasc Anesth. 2020 Oct;34(10):2628-2637. doi: 10.1053/j.jvca.2020.04.052. Epub 2020 May 15.
Patients experiencing prolonged critical illness after cardiac surgery represent a resource- intensive group with a high risk of mortality. The authors sought to derive and validate a multivariate model that accurately predicts 1-year mortality in people who have been critically ill for at least 1 week after cardiac surgery.
This was a retrospective population-based cohort study using linked administrative data.
Eleven hospitals providing cardiac surgical care in the Canadian province of Ontario.
All adult patients aged ≥18 years undergoing 1 of the 5 most common major cardiac surgical procedures between April 1, 2009, and March 31, 2014.
None.
The authors' primary exposure was presence in an intensive care unit on the seventh postoperative day (POD7) and the primary outcome was all-cause mortality occurring after POD7 and within 1 year from the date of surgery. Candidate predictors included patient demographics, surgical details, preoperative medical conditions, postoperative status, and life supportive therapies utilized on POD7. Descriptive statistics were used to compare predictor variables between participants who did or did not die in the year after surgery. The prediction model was derived in the full data set using logistic regression and the prespecified set of predictor variables. A total of 2,031 individuals remained in an intensive care unit on POD7 (4.8% of all cardiac surgery patients). Five hundred twenty-one people died (25.6%) in the year after surgery; 353 died before hospital discharge (17.3% of total cohort, 67.8% of deaths). Requirement for multiple vasoactive or inotropic medications was the strongest predictor of mortality, followed by need for invasive ventilation, 3 or more preoperative comorbidities, need for a single inotropic or vasoactive medication, and requirement for dialysis before surgery. The derivation area under the curve was 0.80, and the model was well- calibrated with a Hosmer-Lemeshow p value of 0.5 and good calibration across risk deciles.
A prespecified multivariate model using clinically relevant, routinely available variables was able to accurately predict death among those with prolonged critical illness after cardiac surgery.
经历心脏手术后长时间重症监护的患者是一个资源密集型群体，其死亡率很高。作者试图建立并验证一个多变量模型，以准确预测心脏手术后至少 1 周处于重症监护状态的患者在 1 年内的死亡率。
这是一项基于人群的回顾性队列研究，使用了关联的行政数据。
加拿大安大略省提供心脏外科护理的 11 家医院。
2009 年 4 月 1 日至 2014 年 3 月 31 日期间，年龄≥18 岁，接受 5 种最常见的主要心脏外科手术之一的所有成年患者。
无。
作者的主要暴露因素是术后第 7 天（POD7）在重症监护病房（ICU）中，主要结局是术后 POD7 内和手术日期后 1 年内发生的全因死亡率。候选预测因素包括患者人口统计学、手术细节、术前医疗状况、术后状况以及 POD7 时使用的生命支持治疗。使用描述性统计比较了手术后 1 年内死亡和未死亡的参与者之间的预测变量。使用逻辑回归和预设的预测变量集在全数据集推导预测模型。共有 2031 人在 POD7 时留在 ICU（所有心脏手术患者的 4.8%）。521 人在手术后 1 年内死亡（总队列的 25.6%，全部死亡的 67.8%）。需要多种血管活性或正性肌力药物是死亡率最强的预测因素，其次是需要侵入性通气、术前合并症≥3 种、需要单一正性肌力或血管活性药物以及手术前需要透析。推导的曲线下面积为 0.80，模型具有良好的校准度，Hosmer-Lemeshow p 值为 0.5，风险十分位数之间具有良好的校准度。
使用临床相关的常规可用变量建立的预设多变量模型能够准确预测心脏手术后长时间重症监护患者的死亡。
