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比较血管活性-正性肌力评分、血管活性-通气-肾脏评分和改良血管活性-通气-肾脏评分预测冠状动脉旁路移植术后不良预后。

Comparison of vasoactive-inotropic score, vasoactive-ventilation-renal score, and modified vasoactive-ventilation-renal score for predicting the poor prognosis after coronary artery bypass grafting.

机构信息

Department of Cardiac Critical Care Medicine, Affiliated Hospital of Jining Medical University, No.89 Guhuai Road, Rencheng District, 272000, Jining, P.R. China.

出版信息

BMC Cardiovasc Disord. 2023 May 24;23(1):274. doi: 10.1186/s12872-023-03313-9.

Abstract

BACKGROUND

Exploring reliable prediction scoring systems is valuable for the poor prognosis of patients after coronary artery bypass grafting (CABG). Herein, we explored and compared the predictive performance of vasoactive-inotropic score (VIS), vasoactive-ventilation-renal (VVR) score, and modified VVR (M-VVR) score in the poor prognosis of patients undergoing CABG.

METHODS

A retrospective cohort study was performed in Affiliated Hospital of Jining Medical University, and data of 537 patients were collected from January 2019 to May 2021. The independent variables were VIS, VVR, and M-VVR. Study endpoint of interest was the poor prognosis. Association between VIS, VVR, M-VVR and poor prognosis was assessed using logistic regression analysis, and odds ratios (OR) and 95% confidence intervals (CIs) were reported. The performance of VIS, VVR, and M-VVR to predict the poor prognosis was assessed by calculating the area under the curve (AUC), and differences of the AUC of the three scoring systems were compared using DeLong test.

RESULTS

After adjusting gender, BMI, hypertension, diabetes, surgery methods, and left ventricular ejection fraction (LVEF), VIS (OR: 1.09, 95%CI: 1.05-1.13) and M-VVR (OR: 1.09, 95%CI: 1.06-1.12) were associated with the increased odds of poor prognosis. The AUC of M-VVR, VVR, and VIS was 0.720 (95%CI: 0.668-0.771), 0.621 (95%CI: 0.566-0.677), and 0.685 (95%CI: 0.631-0.739), respectively. DeLong test displayed that the performance of M-VVR was better than VVR (P = 0.004) and VIS (P = 0.003).

CONCLUSIONS

Our study found the good prediction performance of M-VVR for the poor prognosis of patients undergoing CABG, indicating that M-VVR may be a useful prediction index in the clinic.

摘要

背景

探索可靠的预测评分系统对于评估冠状动脉旁路移植术(CABG)后患者的预后不良情况具有重要意义。本研究旨在探讨和比较血管活性-正性肌力评分(VIS)、血管活性-通气-肾功能(VVR)评分和改良 VVR(M-VVR)评分在 CABG 患者预后不良中的预测效能。

方法

采用回顾性队列研究方法,收集 2019 年 1 月至 2021 年 5 月在济宁医学院附属医院接受 CABG 治疗的 537 例患者的数据。自变量为 VIS、VVR 和 M-VVR。研究终点为预后不良。采用 logistic 回归分析评估 VIS、VVR 和 M-VVR 与预后不良的相关性,并报告比值比(OR)和 95%置信区间(CI)。通过计算曲线下面积(AUC)评估 VIS、VVR 和 M-VVR 预测预后不良的性能,并采用 DeLong 检验比较三种评分系统 AUC 的差异。

结果

在校正性别、BMI、高血压、糖尿病、手术方式和左心室射血分数(LVEF)后,VIS(OR:1.09,95%CI:1.05-1.13)和 M-VVR(OR:1.09,95%CI:1.06-1.12)与预后不良的可能性增加相关。M-VVR、VVR 和 VIS 的 AUC 分别为 0.720(95%CI:0.668-0.771)、0.621(95%CI:0.566-0.677)和 0.685(95%CI:0.631-0.739)。DeLong 检验显示,M-VVR 的性能优于 VVR(P=0.004)和 VIS(P=0.003)。

结论

本研究发现 M-VVR 对 CABG 患者预后不良具有良好的预测性能,表明 M-VVR 可能是临床有用的预测指标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d5f/10210316/45f7bc2f02d0/12872_2023_3313_Fig1_HTML.jpg

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