中国人群困难视频喉镜检查回归模型及列线图的开发与验证：一项前瞻性、单中心、巢式病例对照研究

Development and validation of a regression model with nomogram for difficult video laryngoscopy in Chinese population: a prospective, single-center, and nested case-control study.

作者信息

Jin Chenyu, Pei Bei, Cao Shuang, Ji Ningning, Xia Ming, Jiang Hong

机构信息

Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Front Med (Lausanne). 2023 Sep 1;10:1197536. doi: 10.3389/fmed.2023.1197536. eCollection 2023.

DOI:10.3389/fmed.2023.1197536

PMID:37727768

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10505806/

Abstract

BACKGROUND

Airway management failure is associated with increased perioperative morbidity and mortality. Airway-related complications can be significantly reduced if difficult laryngoscopy is predicted with high accuracy. Currently, there are no large-sample studies on difficult airway assessments in Chinese populations. An airway assessment model based on the Chinese population is urgently needed to guide airway rescue strategy.

METHODS

This prospective nested case-control study took place in a tertiary hospital in Shanghai, China. Information on 10,549 patients was collected, and 8,375 patients were enrolled, including 7,676 patients who underwent successful laryngoscopy and 699 patients who underwent difficult laryngoscopy. The baseline characteristics, medical history, and bedside examinations were included as predictor variables. Laryngoscopy was defined as 'successful laryngoscopy' based on a Cormack-Lehane Grades of 1-2 and as 'difficult laryngoscopy' based on a Cormack-Lehane Grades of 3-4. A model was developed by incorporating risk factors and was presented in the form of a nomogram by univariate logistic regression, least absolute shrinkage and selection operator, and stepwise logistic regression. The main outcome measures were area under the curve (AUC), sensitivity, and specificity of the predictive model.

RESULT

The AUC value of the prediction model was 0.807 (95% confidence interval [CI]: 0.787-0.828), with a sensitivity of 0.730 (95% CI, 0.690-0.769) and a specificity of 0.730 (95% CI, 0.718-0.742) in the training set. The AUC value of the prediction model was 0.829 (95% CI, 0.800-0.857), with a sensitivity of 0.784 (95% CI, 0.73-0.838) and a specificity of 0.722 (95% CI, 0.704-0.740) in the validation set.

CONCLUSION

Our model had accurate predictive performance, good clinical utility, and good robustness for difficult laryngoscopy in the Chinese population.

摘要

背景

气道管理失败与围手术期发病率和死亡率增加相关。如果能高精度预测困难喉镜检查，气道相关并发症可显著减少。目前，尚无针对中国人群进行困难气道评估的大样本研究。迫切需要一个基于中国人群的气道评估模型来指导气道抢救策略。

方法

这项前瞻性巢式病例对照研究在中国上海的一家三级医院进行。收集了10549例患者的信息，纳入8375例患者，其中7676例患者喉镜检查成功，699例患者喉镜检查困难。将基线特征、病史和床边检查作为预测变量。根据Cormack-Lehane分级1-2级定义为“成功喉镜检查”，3-4级定义为“困难喉镜检查”。通过纳入危险因素建立模型，并通过单因素逻辑回归、最小绝对收缩和选择算子以及逐步逻辑回归以列线图的形式呈现。主要结局指标为预测模型的曲线下面积（AUC）、敏感性和特异性。

结果

预测模型在训练集中的AUC值为0.807（95%置信区间[CI]：0.787-0.828），敏感性为0.730（95%CI，0.690-0.769），特异性为0.730（95%CI，0.718-0.742）。预测模型在验证集中的AUC值为0.829（95%CI，0.800-0.857），敏感性为0.784（95%CI，0.73-0.838），特异性为0.722（95%CI，0.704-0.740）。