Yu Byungchul, Cho Jayun, Kang Byung Hee, Kim Kyounghwan, Kim Dong Hun, Chang Sung Wook, Jung Pil Young, Heo Yoonjung, Kang Wu Seong
Traumatology, Gachon University College of Medicine, Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Sci Rep. 2024 Apr 22;14(1):9164. doi: 10.1038/s41598-024-59861-3.
Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) had been introduced as an innovative procedure for severe hemorrhage in the abdomen or pelvis. We aimed to investigate risk factors associated with mortality after REBOA and construct a model for predicting mortality. This multicenter retrospective study collected data from 251 patients admitted at five regional trauma centers across South Korea from 2015 to 2022. The indications for REBOA included patients experiencing hypovolemic shock due to hemorrhage in the abdomen, pelvis, or lower extremities, and those who were non-responders (systolic blood pressure (SBP) < 90 mmHg) to initial fluid treatment. The primary and secondary outcomes were mortality due to exsanguination and overall mortality, respectively. After feature selection using the least absolute shrinkage and selection operator (LASSO) logistic regression model to minimize overfitting, a multivariate logistic regression (MLR) model and nomogram were constructed. In the MLR model using risk factors selected in the LASSO, five risk factors, including initial heart rate (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.98-1.00; p = 0.030), initial Glasgow coma scale (aOR, 0.86; 95% CI 0.80-0.93; p < 0.001), RBC transfusion within 4 h (unit, aOR, 1.12; 95% CI 1.07-1.17; p < 0.001), balloon occlusion type (reference: partial occlusion; total occlusion, aOR, 2.53; 95% CI 1.27-5.02; p = 0.008; partial + total occlusion, aOR, 2.04; 95% CI 0.71-5.86; p = 0.187), and post-REBOA systolic blood pressure (SBP) (aOR, 0.98; 95% CI 0.97-0.99; p < 0.001) were significantly associated with mortality due to exsanguination. The prediction model showed an area under curve, sensitivity, and specificity of 0.855, 73.2%, and 83.6%, respectively. Decision curve analysis showed that the predictive model had increased net benefits across a wide range of threshold probabilities. This study developed a novel intuitive nomogram for predicting mortality in patients undergoing REBOA. Our proposed model exhibited excellent performance and revealed that total occlusion was associated with poor outcomes, with post-REBOA SBP potentially being an effective surrogate measure.
最近，主动脉内复苏球囊阻断术（REBOA）已作为一种针对腹部或盆腔严重出血的创新手术被引入。我们旨在研究与REBOA术后死亡率相关的危险因素，并构建一个预测死亡率的模型。这项多中心回顾性研究收集了2015年至2022年期间韩国五个地区创伤中心收治的251例患者的数据。REBOA的适应证包括因腹部、盆腔或下肢出血而出现低血容量性休克的患者，以及对初始液体治疗无反应（收缩压[SBP]<90mmHg）的患者。主要和次要结局分别是失血性死亡和全因死亡。在使用最小绝对收缩和选择算子（LASSO）逻辑回归模型进行特征选择以最小化过拟合后，构建了多变量逻辑回归（MLR）模型和列线图。在使用LASSO中选择的危险因素的MLR模型中，五个危险因素，包括初始心率（调整后的优势比[aOR]，0.99；95%置信区间[CI]，0.98 - 1.00；p = 0.030）、初始格拉斯哥昏迷量表评分（aOR，0.86；95%CI 0.80 - 0.93；p < 0.001）、4小时内红细胞输注量（单位，aOR，1.12；95%CI 1.07 - 1.17；p < 0.001）、球囊阻断类型（参考：部分阻断；完全阻断，aOR，2.53；95%CI 1.27 - 5.02；p = 0.008；部分+完全阻断，aOR，2.04；95%CI 0.71 - 5.86；p = 0.187）以及REBOA术后收缩压（SBP）（aOR，0.98；95%CI 0.97 - 0.99；p < 0.001）与失血性死亡显著相关。预测模型的曲线下面积、敏感性和特异性分别为0.855、73.2%和83.6%。决策曲线分析表明，预测模型在广泛的阈值概率范围内具有增加的净效益。本研究开发了一种用于预测接受REBOA治疗患者死亡率的新型直观列线图。我们提出的模型表现出优异的性能，并表明完全阻断与不良结局相关，REBOA术后SBP可能是一种有效的替代指标。
