预测 ICU 中缺血性卒中或脑出血患者的 30 天死亡率。
Predicting 30-day mortality in intensive care unit patients with ischaemic stroke or intracerebral haemorrhage.
机构信息
From the Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht (MKvV, AJCS), Department of Anaesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda (MKvV), National Intensive Care Evaluation Foundation, Amsterdam University Medical Center (FT, SB, MSA), Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam (FT, SB), Healthplus.ai BV, Amsterdam (BFG), Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen (WFA), Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen (WMvdB), Department of Intensive Care, Amsterdam University Medical Center, Amsterdam (JH), Department of Intensive Care Medicine, and Academy for Postgraduate Training, Maastricht University Medical Center (WNKAvM), School of Health Professions Education, Maastricht University, Maastricht (WNKAvM), the UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (AJCS), Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium (AJCS), Department of Neurology, Leiden University Medical Center, Leiden (MJHW), Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen (MJHW), Department of Clinical Epidemiology, Leiden University Medical Center (BS, MSA), Department of Intensive Care, Leiden University Medical Center, Leiden, the Netherlands (MSA).
出版信息
Eur J Anaesthesiol. 2024 Feb 1;41(2):136-145. doi: 10.1097/EJA.0000000000001920. Epub 2023 Nov 14.
BACKGROUND
Stroke patients admitted to an intensive care unit (ICU) follow a particular survival pattern with a high short-term mortality, but if they survive the first 30 days, a relatively favourable subsequent survival is observed.
OBJECTIVES
The development and validation of two prognostic models predicting 30-day mortality for ICU patients with ischaemic stroke and for ICU patients with intracerebral haemorrhage (ICH), analysed separately, based on parameters readily available within 24 h after ICU admission, and with comparison with the existing Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) model.
DESIGN
Observational cohort study.
SETTING
All 85 ICUs participating in the Dutch National Intensive Care Evaluation database.
PATIENTS
All adult patients with ischaemic stroke or ICH admitted to these ICUs between 2010 and 2019.
MAIN OUTCOME MEASURES
Models were developed using logistic regressions and compared with the existing APACHE-IV model. Predictive performance was assessed using ROC curves, calibration plots and Brier scores.
RESULTS
We enrolled 14 303 patients with stroke admitted to ICU: 8422 with ischaemic stroke and 5881 with ICH. Thirty-day mortality was 27% in patients with ischaemic stroke and 41% in patients with ICH. Important factors predicting 30-day mortality in both ischaemic stroke and ICH were age, lowest Glasgow Coma Scale (GCS) score in the first 24 h, acute physiological disturbance (measured using the Acute Physiology Score) and the application of mechanical ventilation. Both prognostic models showed high discrimination with an AUC 0.85 [95% confidence interval (CI), 0.84 to 0.87] for patients with ischaemic stroke and 0.85 (0.83 to 0.86) in ICH. Calibration plots and Brier scores indicated an overall good fit and good predictive performance. The APACHE-IV model predicting 30-day mortality showed similar performance with an AUC of 0.86 (95% CI, 0.85 to 0.87) in ischaemic stroke and 0.87 (0.86 to 0.89) in ICH.
CONCLUSION
We developed and validated two prognostic models for patients with ischaemic stroke and ICH separately with a high discrimination and good calibration to predict 30-day mortality within 24 h after ICU admission.
TRIAL REGISTRATION
Trial registration: Dutch Trial Registry ( https://www.trialregister.nl/ ); identifier: NTR7438.
背景
入住重症监护病房（ICU）的中风患者有特定的生存模式，短期死亡率较高，但如果他们能在 30 天内存活，随后的生存情况则相对较好。
目的
分别为 ICU 收治的缺血性中风患者和颅内出血（ICH）患者开发和验证两种预测 30 天死亡率的预后模型，这些模型基于 ICU 入院后 24 小时内即可获得的参数，与现有的急性生理学和慢性健康评估第四版（APACHE-IV）模型进行比较。
设计
观察性队列研究。
设置
所有参与荷兰国家重症监护评估数据库的 85 个 ICU。
患者
2010 年至 2019 年期间入住这些 ICU 的所有成年缺血性中风或 ICH 患者。
主要观察指标
使用逻辑回归建立模型，并与现有的 APACHE-IV 模型进行比较。使用 ROC 曲线、校准图和 Brier 评分评估预测性能。
结果
我们纳入了 14303 名入住 ICU 的中风患者：8422 名缺血性中风患者和 5881 名 ICH 患者。缺血性中风患者的 30 天死亡率为 27%，ICH 患者为 41%。在缺血性中风和 ICH 中，预测 30 天死亡率的重要因素包括年龄、24 小时内最低格拉斯哥昏迷量表（GCS）评分、急性生理紊乱（使用急性生理评分测量）和机械通气的应用。两种预后模型在预测缺血性中风和 ICH 患者的 30 天死亡率方面均具有较高的区分度，AUC 分别为 0.85[95%置信区间（CI），0.84 至 0.87]和 0.85（0.83 至 0.86）。校准图和 Brier 评分表明总体拟合良好，预测性能良好。预测 30 天死亡率的 APACHE-IV 模型在缺血性中风中的 AUC 为 0.86（95%CI，0.85 至 0.87），在 ICH 中的 AUC 为 0.87（0.86 至 0.89），表现出类似的性能。
结论
我们分别为缺血性中风和 ICH 患者开发和验证了两种预后模型，具有较高的区分度和良好的校准度，可在 ICU 入院后 24 小时内预测 30 天死亡率。
试验注册
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