Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Sci Rep. 2024 Nov 5;14(1):26741. doi: 10.1038/s41598-024-78482-4.
Assessing the risk of postoperative cardiovascular events before performing non-cardiac surgery is clinically important. The current risk score systems for preoperative evaluation may not adequately represent a small subset of high-risk populations. Accordingly, this study aimed at applying iterative random forest to analyze combinations of factors that could potentially be clinically valuable in identifying these high-risk populations. To this end, we used the Japan Medical Data Center database, which includes claims data from Japan between January 2005 and April 2021, and employed iterative random forests to extract factor combinations that influence outcomes. The analysis demonstrated that a combination of a prior history of stroke and extremely low LDL-C levels was associated with a high non-cardiac postoperative risk. The incidence of major adverse cardiovascular events in the population characterized by the incidence of previous stroke and extremely low LDL-C levels was 15.43 events per 100 person-30 days [95% confidence interval, 6.66-30.41] in the test data. At this stage, the results only show correlation rather than causation; however, these findings may offer valuable insights for preoperative risk assessment in non-cardiac surgery.
在进行非心脏手术前评估术后心血管事件的风险具有重要的临床意义。目前用于术前评估的风险评分系统可能无法充分代表一小部分高危人群。因此，本研究旨在应用迭代随机森林分析可能对识别这些高危人群具有临床价值的因素组合。为此，我们使用了日本医疗数据中心数据库，该数据库包含了 2005 年 1 月至 2021 年 4 月期间来自日本的理赔数据，并利用迭代随机森林提取影响结果的因素组合。分析表明，既往卒中史和极低 LDL-C 水平的组合与非心脏手术后的高风险相关。在测试数据中，具有既往卒中史和极低 LDL-C 水平特征的人群中主要不良心血管事件的发生率为每 100 人-30 天 15.43 例[95%置信区间，6.66-30.41]。在现阶段，结果仅显示相关性而不是因果关系；然而，这些发现可能为非心脏手术的术前风险评估提供有价值的见解。
