高 CHADS-VASc 评分与冠心病监护病房患者短期和长期死亡率的关系。
The Association Between High CHADS-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients.
机构信息
Department of Cardiovascular Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, P.R. China.
Department of Cardiovascular Medicine, East Hospital, 66324Tongji University School of Medicine, Shanghai, China.
出版信息
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221117969. doi: 10.1177/10760296221117969.
BACKGROUND
The CHADS-VASc score has been associated with the prognosis of cardiovascular diseases. This study aimed to explore the association between the CHADS-VASc score and all-cause mortality in coronary care unit (CCU) patients.
METHODS
The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. CCU patients were divided into two groups according to CHADS-VASc score: 0-3 (low risk)，4-9 (intermediate and high risk). The primary outcome was 30-day mortality, and the secondary endpoints included in-hospital, 1-year, and 5-year mortality. Propensity score matching (PSM) and sensitivity analyzes for the confounders were also performed. The restricted cubic splines flexibility model was used to demonstrate the relation between red blood cell volume distribution width (RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC), hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in the 0-3 score versus the 4-9 score groups after PSM.
RESULTS
Among 4491 eligible patients, 988 patients with low CHADS-VASc scores and 988 patients with intermediate and high CHADS-VASc scores had similar propensity scores and were included in the analyzes. In the survival analysis, the patients with intermediate and high CHADS-VASc scores were associated with higher 30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI), 1.02-1.20, = .014], 1-year mortality [HR: 1.13; 95%CI, 1.06-1.19, < .001], and 5-year mortality [HR: 1.13; 95%CI, 1.07-1.18, < .001]. The interaction for 30-day mortality among subgroups was not significant between the 0-3 score versus the 4-9 score groups. The restricted cubic splines for 30-day mortality demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped trajectory for WBC, glucose and potassium, and a U-shaped trajectory for sodium, respectively (all nonlinear <.001).
CONCLUSIONS
A high CHADS-VASc score was an independent risk for 30-day, 1-year, and 5-year mortality for CCU patients.
背景
CHADS-VASc 评分与心血管疾病的预后相关。本研究旨在探讨 CHADS-VASc 评分与冠心病监护病房（CCU）患者全因死亡率之间的关系。
方法
本研究基于医疗信息集市重症监护（MIMIC）III 数据库。根据 CHADS-VASc 评分将 CCU 患者分为两组：0-3 分（低危），4-9 分（中高危）。主要结局为 30 天死亡率，次要结局包括住院期间、1 年和 5 年死亡率。还对混杂因素进行了倾向评分匹配（PSM）和敏感性分析。使用限制立方样条灵活性模型，展示匹配前后两组红细胞体积分布宽度（RDW）、血尿素氮（BUN）、血小板、白细胞（WBC）、血红蛋白、磷、葡萄糖、钾、钠与 30 天死亡率的关系。
结果
在 4491 名合格患者中，988 名低 CHADS-VASc 评分患者和 988 名中高危 CHADS-VASc 评分患者的倾向评分相似，均纳入分析。生存分析显示，中高危 CHADS-VASc 评分患者 30 天死亡率较高[风险比（HR）：1.11；95%置信区间（CI）：1.02-1.20，= 0.014]、1 年死亡率较高[HR：1.13；95%CI：1.06-1.19，< 0.001]和 5 年死亡率较高[HR：1.13；95%CI：1.07-1.18，< 0.001]。两组之间 30 天死亡率的亚组交互作用无统计学意义。30 天死亡率的限制立方样条显示血小板和血红蛋白呈 L 型轨迹，WBC、葡萄糖和钾呈 J 型轨迹，钠呈 U 型轨迹（所有非线性均< 0.001）。
结论
CHADS-VASc 评分较高是 CCU 患者 30 天、1 年和 5 年死亡的独立危险因素。
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