Emergency Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.369 Yingbin Road, Nanyuan Street, Linping District, Hangzhou, 311100, Zhejiang, China.
J Orthop Surg Res. 2023 Nov 16;18(1):870. doi: 10.1186/s13018-023-04364-6.
This study aimed to explore the value of the Charlson comorbidity index (CCI) in predicting ICU admission in patients with aortic aneurysm (AA).
The clinical data of patients were obtained from the Medical Information Mart for Intensive Care-IV database. The association between CCI and ICU admission was explored by restricted cubic spline (RCS), threshold effect analysis, generalized linear model, logistic regression, interaction, and mediation analyses. Its clinical value was evaluated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), DeLong's test, and net reclassification index (NRI) analyses.
The ICU admission was significantly associated with the thoracic AA (TAA), unruptured status, and surgery status. Therefore, 288 candidate patients with unruptured TAA who received surgery were enrolled in the further analysis. We found that CCI was independently associated with the ICU admission of candidates (P = 0.005). Further, their nonlinear relationship was observed (adjusted P = 0.008), and a significant turning point of 6 was identified. The CCI had a favorable performance in predicting ICU admission (area under curve = 0.728) and achieved a better clinical net benefit. New models based on CCI significantly improved the accuracy of prediction. Besides the importance of CCI in ICU admission, CCI also exerted important interaction effect (rather than mediating effects) on the association of other variables (such as age and blood variables) with ICU admission requirements (all P < 0.05).
The CCI is an important predictor of ICU admission after surgery in patients with unruptured TAA.
本研究旨在探讨 Charlson 合并症指数（CCI）在预测主动脉瘤（AA）患者入住 ICU 中的价值。
从 Medical Information Mart for Intensive Care-IV 数据库中获取患者的临床数据。采用受限立方样条（RCS）、阈值效应分析、广义线性模型、逻辑回归、交互和中介分析探讨 CCI 与 ICU 入住的关系。通过决策曲线分析（DCA）、受试者工作特征曲线（ROC）、DeLong 检验和净重新分类指数（NRI）分析评估其临床价值。
ICU 入住与胸主动脉瘤（TAA）、未破裂状态和手术状态显著相关。因此，进一步纳入了 288 名接受手术的未破裂 TAA 候选患者进行分析。结果发现，CCI 与候选者的 ICU 入住独立相关（P=0.005）。此外，还观察到它们之间存在非线性关系（调整后的 P=0.008），并确定了 6 为显著转折点。CCI 在预测 ICU 入住方面表现良好（曲线下面积=0.728），并实现了更好的临床净获益。基于 CCI 的新模型显著提高了预测的准确性。除了 CCI 在 ICU 入住中的重要性外，CCI 还对其他变量（如年龄和血液变量）与 ICU 入住要求的关联产生重要的交互作用（均 P<0.05）。
CCI 是预测未破裂 TAA 患者手术后 ICU 入住的重要指标。
