急性ST段抬高型心肌梗死患者院内出血的诊断模型：算法开发与验证
Diagnostic Model for In-Hospital Bleeding in Patients with Acute ST-Segment Elevation Myocardial Infarction: Algorithm Development and Validation.
作者信息
Li Yong
机构信息
Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
出版信息
JMIR Med Inform. 2020 Aug 14;8(8):e20974. doi: 10.2196/20974.
BACKGROUND
Bleeding complications in patients with acute ST-segment elevation myocardial infarction (STEMI) have been associated with increased risk of subsequent adverse consequences.
OBJECTIVE
The objective of our study was to develop and externally validate a diagnostic model of in-hospital bleeding.
METHODS
We performed multivariate logistic regression of a cohort for hospitalized patients with acute STEMI in the emergency department of a university hospital. Participants: The model development data set was obtained from 4262 hospitalized patients with acute STEMI from January 2002 to December 2013. A set of 6015 hospitalized patients with acute STEMI from January 2014 to August 2019 were used for external validation. We used logistic regression analysis to analyze the risk factors of in-hospital bleeding in the development data set. We developed a diagnostic model of in-hospital bleeding and constructed a nomogram. We assessed the predictive performance of the diagnostic model in the validation data sets by examining measures of discrimination, calibration, and decision curve analysis (DCA).
RESULTS
In-hospital bleeding occurred in 112 of 4262 participants (2.6%) in the development data set. The strongest predictors of in-hospital bleeding were advanced age and high Killip classification. Logistic regression analysis showed differences between the groups with and without in-hospital bleeding in age (odds ratio [OR] 1.047, 95% CI 1.029-1.066; P<.001), Killip III (OR 3.265, 95% CI 2.008-5.31; P<.001), and Killip IV (OR 5.133, 95% CI 3.196-8.242; P<.001). We developed a diagnostic model of in-hospital bleeding. The area under the receiver operating characteristic curve (AUC) was 0.777 (SD 0.021, 95% CI 0.73576-0.81823). We constructed a nomogram based on age and Killip classification. In-hospital bleeding occurred in 117 of 6015 participants (1.9%) in the validation data set. The AUC was 0.7234 (SD 0.0252, 95% CI 0.67392-0.77289).
CONCLUSIONS
We developed and externally validated a diagnostic model of in-hospital bleeding in patients with acute STEMI. The discrimination, calibration, and DCA of the model were found to be satisfactory.
TRIAL REGISTRATION
ChiCTR.org ChiCTR1900027578; http://www.chictr.org.cn/showprojen.aspx?proj=45926.
背景
急性ST段抬高型心肌梗死（STEMI）患者的出血并发症与随后发生不良后果的风险增加相关。
目的
我们研究的目的是开发并外部验证一种院内出血的诊断模型。
方法
我们对一所大学医院急诊科收治的急性STEMI住院患者队列进行了多因素逻辑回归分析。参与者：模型开发数据集来自2002年1月至2013年12月期间4262例急性STEMI住院患者。2014年1月至2019年8月期间的6015例急性STEMI住院患者用于外部验证。我们使用逻辑回归分析来分析开发数据集中院内出血的危险因素。我们开发了一种院内出血的诊断模型并构建了一个列线图。我们通过检查区分度、校准度和决策曲线分析（DCA）指标来评估诊断模型在验证数据集中的预测性能。
结果
在开发数据集中，4262名参与者中有112名（2.6%）发生了院内出血。院内出血的最强预测因素是高龄和高Killip分级。逻辑回归分析显示，有和没有院内出血的两组在年龄（比值比[OR]1.047，95%置信区间1.029 - 1.066；P <.001）、Killip III级（OR 3.265，95%置信区间2.008 - 5.31；P <.001）和Killip IV级（OR 5.133，95%置信区间3.196 - 8.242；P <.001）方面存在差异。我们开发了一种院内出血的诊断模型。受试者操作特征曲线（AUC）下的面积为0.777（标准差0.021，95%置信区间0.73576 - 0.81823）。我们基于年龄和Killip分级构建了一个列线图。在验证数据集中，6015名参与者中有117名（1.9%）发生了院内出血。AUC为0.7234（标准差0.0252，95%置信区间0.67392 - 0.77289）。
结论
我们开发并外部验证了一种急性STEMI患者院内出血的诊断模型。发现该模型的区分度、校准度和DCA令人满意。
试验注册
中国临床试验注册中心ChiCTR.org ChiCTR1900027578；http://www.chictr.org.cn/showprojen.aspx?proj=45926 。
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