Tu J V, Mazer C D, Levinton C, Armstrong P W, Naylor C D
Department of Medicine, St. Michael's Hospital, Toronto, Ont.
CMAJ. 1994 Jul 15;151(2):177-85.
To develop a predictive index for length of stay in the intensive care unit (ICU) following cardiac surgery.
Univariate and multivariate logistic regression analysis of a cohort of 1404 patients divided into a derivation set of 713 patients and a validation set of 691 patients.
St. Michael's Hospital, Toronto, a tertiary care cardiovascular centre.
A consecutive sample of all patients undergoing cardiac surgery between Jan. 1 and Dec. 31, 1990 (derivation set), and Jan. 1 and Dec. 31, 1991 (validation set).
A long ICU stay (more than 2 days). Other outcomes analysed were ICU stays over 4, 7 and 10 days, and death.
In the derivation set increasing age, female sex, left ventricular function, type of surgery, and urgency of surgery were found to be independent risk factors for a long ICU stay in a multivariate logistic regression analysis. A predictive index was created by assigning risk scores based on the odds ratios of the significant variables in the logistic regression analysis. The predictive index was found to predict lengths of ICU stay greater than 2, 4, 7 and 10 days, and patient death in the validation set.
Length of ICU stay and death following cardiac surgery can be predicted with a multivariate predictive index. The index has potential application as a means of stratifying cardiac surgical risk as well as in optimizing ICU resource planning when resources are limited.
制定心脏手术后重症监护病房（ICU）住院时间的预测指标。
对1404例患者组成的队列进行单因素和多因素逻辑回归分析，该队列分为713例患者的推导集和691例患者的验证集。
多伦多圣迈克尔医院，一家三级心血管护理中心。
1990年1月1日至12月31日（推导集）以及1991年1月1日至12月31日（验证集）期间所有接受心脏手术患者的连续样本。
ICU长时间住院（超过2天）。分析的其他结局包括ICU住院超过4天、7天和10天以及死亡情况。
在推导集中，多因素逻辑回归分析发现年龄增加、女性、左心室功能、手术类型和手术紧急程度是ICU长时间住院的独立危险因素。通过根据逻辑回归分析中显著变量的比值比分配风险评分创建了一个预测指标。该预测指标在验证集中可预测ICU住院时间超过2天、4天、7天和10天以及患者死亡情况。
心脏手术后ICU住院时间和死亡情况可用多因素预测指标进行预测。该指标有可能作为一种对心脏手术风险进行分层的手段，以及在资源有限时优化ICU资源规划的工具。
