Association of Critical Value With 28-Day Mortality After Cardiac Surgery.

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-02-28 DOI:10.1532/hsf.5215
Huan Xu, Yin-Ying Xue, Xiao Shen, Liang Hong, Cui Zhang
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Abstract

Objective: The emergence of critical values gives a warning to the medical safety of hospitalized patients, especially Cardiosurgery Intensive Care Unit (CSICU) patients. The aim of this study was to investigate the association between early postoperative critical values and the prognosis of patients after cardiac surgery.

Methods: Clinical data of the patients were obtained from the Cardiac Critical Care Clinical Database of the Cardiovascular Intensive Care Unit of Nanjing First Hospital. A total of 1,598 consecutive patients undergoing cardiac surgery were enrolled in this retrospective cohort study, during the period from July 2019 to December 2020. According to whether critical value occurred within 7 days after cardiac surgery, patients were divided into two groups: the critical value group and control group. COX regression and survival analysis were performed to analyze the clinical data of the two groups. The area under the receiver operating characteristic curve (ROC) was used to assess the critical value's predictive value and determine the optimal cutoff value.

Results: With patients in the critical value group, the 28-day mortality after cardiac surgery was 21.98%, significantly higher than that of the control group (P < 0.05). Logistic regression analysis revealed the APACHE II score (Adjusted HR-1.11, 95% CI-1.043-1.185) and critical value group (Adjusted HR-13.57, 95% CI-6.714-27.435 ) were independent predictors of 28-day mortality after cardiac surgery. The ROC curve showed that the critical value case model (AUC = 0.748 ± 0.052, P < 0.05) could effectively predict the 28-day mortality, and the optimum cutoff was 1 case (sensitivity 52.63%, specificity 95.70%).

Conclusions: One or more reported cases of critical values in the early postoperative period could be an independent risk factor for 28-day mortality in patients undergoing cardiac surgery. The predictive model based on critical value might be effective in clinical therapy and risk stratification.

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心脏手术后临界值与28天死亡率的关系。
目的:临界值的出现对住院患者特别是心外科重症监护病房(CSICU)患者的医疗安全提出警示。本研究的目的是探讨心脏术后早期临界值与患者预后之间的关系。方法:患者临床资料来源于南京市第一医院心血管重症监护室心脏危重症临床数据库。在2019年7月至2020年12月期间,共有1598名连续接受心脏手术的患者入组了这项回顾性队列研究。根据心脏手术后7天内是否出现临界值,将患者分为临界值组和对照组。采用COX回归和生存分析对两组患者的临床资料进行分析。采用受试者工作特征曲线(ROC)下面积评估临界值的预测值,确定最佳截止值。结果:临界值组患者心脏术后28天死亡率为21.98%,显著高于对照组(P < 0.05)。Logistic回归分析显示,APACHE II评分(Adjusted HR-1.11, 95% CI-1.043-1.185)和临界值组(Adjusted HR-13.57, 95% CI-6.714-27.435)是心脏手术后28天死亡率的独立预测因子。ROC曲线显示,临界值病例模型(AUC = 0.748±0.052,P < 0.05)能有效预测28天死亡率,最佳临界值为1例(敏感性52.63%,特异性95.70%)。结论:术后早期报告的一个或多个临界值病例可能是心脏手术患者28天死亡率的独立危险因素。基于临界值的预测模型可能在临床治疗和风险分层中有效。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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