Department of Intensive Care Unit of Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China.
Heart Surg Forum. 2023 Feb 28;26(1):E126-E130. doi: 10.1532/hsf.5215.
The emergence of critical values gives a warning to the medical safety of hospitalized patients, especially Cardiosurgery Intensive Care Unit (CSICU) patients. The aim of this study was to investigate the association between early postoperative critical values and the prognosis of patients after cardiac surgery.
Clinical data of the patients were obtained from the Cardiac Critical Care Clinical Database of the Cardiovascular Intensive Care Unit of Nanjing First Hospital. A total of 1,598 consecutive patients undergoing cardiac surgery were enrolled in this retrospective cohort study, during the period from July 2019 to December 2020. According to whether critical value occurred within 7 days after cardiac surgery, patients were divided into two groups: the critical value group and control group. COX regression and survival analysis were performed to analyze the clinical data of the two groups. The area under the receiver operating characteristic curve (ROC) was used to assess the critical value's predictive value and determine the optimal cutoff value.
With patients in the critical value group, the 28-day mortality after cardiac surgery was 21.98%, significantly higher than that of the control group (P < 0.05). Logistic regression analysis revealed the APACHE II score (Adjusted HR-1.11, 95% CI-1.043-1.185) and critical value group (Adjusted HR-13.57, 95% CI-6.714-27.435 ) were independent predictors of 28-day mortality after cardiac surgery. The ROC curve showed that the critical value case model (AUC = 0.748 ± 0.052, P < 0.05) could effectively predict the 28-day mortality, and the optimum cutoff was 1 case (sensitivity 52.63%, specificity 95.70%).
One or more reported cases of critical values in the early postoperative period could be an independent risk factor for 28-day mortality in patients undergoing cardiac surgery. The predictive model based on critical value might be effective in clinical therapy and risk stratification.
危急值的出现对住院患者的医疗安全发出了警告，尤其是心胸外科重症监护病房（CSICU）的患者。本研究旨在探讨心脏手术后早期术后危急值与患者预后的关系。
本回顾性队列研究纳入了 2019 年 7 月至 2020 年 12 月期间在南京第一医院心血管重症监护病房心脏危重病临床数据库中接受心脏手术的 1598 例连续患者的临床数据。根据心脏手术后 7 天内是否发生危急值，将患者分为两组：危急值组和对照组。采用 COX 回归和生存分析对两组临床资料进行分析。采用受试者工作特征曲线（ROC）下面积（AUC）评估危急值的预测价值，并确定最佳截断值。
心脏手术后 28 天，危急值组患者的死亡率为 21.98%，明显高于对照组（P<0.05）。Logistic 回归分析显示，急性生理学和慢性健康状况评分Ⅱ（调整后的 HR-1.11，95%CI-1.043-1.185）和危急值组（调整后的 HR-13.57，95%CI-6.714-27.435）是心脏手术后 28 天死亡率的独立预测因子。ROC 曲线显示，危急值病例模型（AUC=0.748±0.052，P<0.05）能有效预测 28 天死亡率，最佳截断值为 1 例（敏感度 52.63%，特异度 95.70%）。
心脏手术后早期出现一个或多个危急值报告可能是心脏手术后 28 天死亡率的独立危险因素。基于危急值的预测模型可能对临床治疗和风险分层有效。
