南方医科大学学报2024，Vol.44Issue(3)：491-498,8.DOI:10.12122/j.issn.1673-4254.2024.03.10
VA-ECMO患者院内死亡风险预测模型的构建及验证:一项多中心、回顾性、病例对照研究
Construction and validation of an in-hospital mortality risk prediction model for patients receiving VA-ECMO:a retrospective multi-center case-control study
摘要
Abstract
Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.关键词
静脉-动脉体外膜肺氧合/死亡率/危险因素/风险预测模型Key words
venoarterial extracorporeal membrane oxygenation/mortality/risk factors/risk pre-diction model引用本文复制引用
戈悦,彭岚,包静娜,段佳欣,刘俐,毛可晴,曾振华,胡鸿彬,陈仲清,李建伟,梁宏开,侯六生,左六二,陈珍,卢剑海,赵新,梁静漪..VA-ECMO患者院内死亡风险预测模型的构建及验证:一项多中心、回顾性、病例对照研究[J].南方医科大学学报,2024,44(3):491-498,8.基金项目
国家自然科学基金(82172175) （82172175）
广东省自然科学基金(2022A1515012040)Supported by National Natural Science Foundation of China(82172175). （2022A1515012040）
