摘要
目的探讨院外心脏骤停(OHCA)患者良好神经功能预测因素并构建决策树预测模型。方法回顾性分析2018年1月至2022年12月沧州市中心医院急诊重症监护病房(EICU)收治的117例OHCA并行心肺复苏(CPR)成功患者的临床资料。根据心脏骤停后3个月时的格拉斯哥-匹兹堡脑功能分级将患者分为良好神经功能组(1~2级)和不良神经功能组(3~5级)。通过单因素及多因素Logistic回归分析识别OHCA患者3个月良好神经功能的预测因素,并基于预测因素构建决策树预测模型。应用受试者工作特征曲线下面积(AUC)评估决策树预测模型的区分度,校准曲线评估决策树预测模型预测结局与观察结局的一致性,决策曲线分析评估决策树预测模型的临床实用性。结果29.1%(34/117)的OHCA患者具有良好神经功能。与不良神经功能组相比,良好神经功能组患者多接受旁观者CPR(χ^(2)=4.81,P=0.028)、可除颤心律比例高(χ^(2)=8.74,P=0.003)、CPR持续时间短(Z=3.36,P=0.001)、肾上腺素用量低(Z=4.69,P<0.001)及血乳酸水平低(Z=3.83,P<0.001)。单因素Logistic回归分析结果显示,旁观者CPR(OR=0.34,95%CI 0.13~0.92,P=0.033)、可除颤心律(OR=0.20,95%CI 0.07~0.63,P=0.006)、CPR持续时间(OR=1.08,95%CI 1.02~1.14,P=0.010)、肾上腺素用量(OR=1.64,95%CI 1.28~2.09,P<0.001)及血乳酸(OR=1.20,95%CI 1.09~1.33,P<0.001)为OHCA患者良好神经功能的独立预测因素。多因素Logistic回归分析结果显示,可除颤心律(OR=0.25,95%CI 0.06~0.95,P=0.041)、CPR持续时间(OR=1.07,95%CI 1.00~1.14,P=0.047)、肾上腺素用量(OR=1.95,95%CI 1.29~2.94,P=0.001)及血乳酸(OR=1.13,95%CI 1.01~1.26,P=0.042)为OHCA患者良好神经功能的独立预测因素。决策树预测模型预测OHCA患者良好神经功能的AUC为0.829(95%CI 0.745~0.912),其敏感度为70.6%,特异度为86.7%。校准曲线图表明决策树预测模型的预测结局与观察结局相一致。决策曲线分析证实决策树预测模型的临床可用性良好。结论可除颤心律、CPR持续时间、肾上腺素用量及血乳酸为OHCA患者良好神经功能的预测因素,决策树模型可预测OHCA患者良好神经功能。
Objective To identify the predictive factors of favorable neurologic function after out-of-hospital cardiac arrest(OHCA)and to establish decision tree prediction model.Methods Clinical data of 117 OHCA patients with successful cardiopulmonary resuscitation(CPR)treated in EICU of Cangzhou Central Hospital from January 2018 to December 2022 were retrospectively analyzed.The patients were divided into favorable neurologic function group(1-2 grades)or poor neurologic function group(3-5 grades)according to the Glasgow-Pittsburgh cerebral performance category 3 months after OHCA.The univariate and multivariate Logistic regression was used to analyze the predictive factors for favorable neurologic function,and decision tree prediction model was established based on predictive factors.The discrimination performance of the decision tree prediction model was assessed by the area under the receiver operating characteristic(AUC)curve,the consistency between the actual outcomes and the predicted probabilities was estimated by the calibration curve,and the clinical practical utility was assessed by the decision curve analysis.Results There were 29.1%(34/117)OHCA patients with favorable neurologic function.Compared with poor neurologic function group,the patients with favorable neurological function had the higher incidence of receiving bystander CPR(χ^(2)=4.81,P=0.028),the higher proportion of shockable rhythm(χ^(2)=8.74,P=0.003),the shorter CPR duration(Z=3.36,P=0.001),the less dosage of epinephrine(Z=4.69,P<0.001),and the lower lactate levels(Z=3.83,P<0.001).Univariate Logistic regression analysis showed that bystander CPR(OR=0.34,95%CI 0.13-0.92,P=0.033),shockable rhythm(OR=0.20,95%CI 0.07-0.63,P=0.006),CPR time(OR=1.08,95%CI 1.02-1.14,P=0.010),epinephrine dosage(OR=1.64,95%CI 1.28-2.09,P<0.001),and serum lactate(OR=1.20,95%CI 1.09-1.33,P<0.001)were independent predictive factors for favorable neurologic function in OHCA patients.Multivariate Logistic regression analysis showed that shockable rhythm(OR=0.25,95%CI 0.06-0.95,P=0.041),CPR time(OR=1.07,95%CI 1.00-1.14,P=0.047),epinephrine dosage(OR=1.95,95%CI 1.29-2.94,P=0.001),and serum lactate(OR=1.13,95%CI 1.01-1.26,P=0.042)were independent predictive factors for favorable neurologic function in OHCA patients.The AUC of the decision tree prediction model for predicting favorable neurologic function in OHCA patients was 0.829(95%CI 0.745-0.912),with sensitivity of 70.6%and specificity of 86.7%.Calibration curves showed good consistency between the predicted probabilities and the observed outcome.Decision curve analysis confirmed the clinical usability of the decision tree prediction model.Conclusions The shockable rhythm,CPR time,epinephrine dosage,and serum lactate are independent predictive factors for favorable neurologic function,and decision tree prediction model can predict favorable neurologic function in OHCA patients.
作者
刘东明
冯顺易
王淑娟
李勇
Liu Dongming;Feng Shunyi;Wang Shujuan;Li Yong(Department of Emergency Medicine,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《中国急救医学》
CAS
CSCD
2024年第1期57-62,共6页
Chinese Journal of Critical Care Medicine
基金
河北省医学科学研究课题项目(20211507)。
关键词
心脏骤停
心肺复苏持续时间
神经功能
决策树
血乳酸
肾上腺素
Cardiac arrest
Cardiopulmonary resuscitation duration
Neurologic function
Decision tree
Serum lactic acid
Epinephrine
