急性肺动脉栓塞院内死亡的危险因素分析及预测模型构建

殷昌靖; 侯燕; 翁剑波

急性肺动脉栓塞院内死亡的危险因素分析及预测模型构建

Analysis of the risk factors of hospital death of acute pulmonary embolism and construction of prediction model

摘要

摘要:
目的： 探讨急性肺动脉栓塞院内死亡的危险因素并构建预测模型。
方法： 选取急诊科收治的急性肺动脉栓塞病人197例，将发生院内死亡的37例病人纳入死亡组，余160例病人纳入存活组。收集2组病人一般资料及相关临床指标，采用单因素分析和logistic多因素回归分析进行分析比较，并根据结果构建预测模型。
结果： 单因素分析显示，收缩压、胸闷、晕厥、电解质紊乱、高血压、糖尿病、pH、氧分压、二氧化碳分压、N末端B型利钠肽原（NT-proBNP）、乳酸、超敏肌钙蛋白（hs-cTn）、右心房内径、左心室射血分数（LVEF）、抗凝和简化版肺栓塞评分（sPESI）危险分层≥1在2组病人间差异均有统计学意义（P ＜ 0.05 ~ P ＜ 0.01）。二元logistic回归分析显示，电解质紊乱、高血压病史、低氧分压、高水平NT-proBNP、高水平hs-cTn、LVEF、sPESI危险分层≥1均为急性肺栓塞院内死亡的独立危险因素（P ＜ 0.05 ~ P ＜ 0.01）。构建预测模型，得到Prob = 1/（e^–Y），Y = 29.945 – 1.507*（电解质紊乱） – 0.089*（高血压） + 3.324*（氧分压） – 1.530*（NT-proBNP） – 0.086*（hs-cTn） + 0.594*（LVEF） – 0.862*（sPESI危险分层≥1）。
结论： 电解质紊乱、高血压病史、氧分压、NT-proBNP、hs-cTn、LVEF、sPESI危险分层均为急性肺栓塞病人院内死亡的独立影响因素，据此构建的预测模型具有较好效能，有助于预测急性肺动脉栓塞病人院内死亡的发生风险，帮助医护人员针对高危病人进行重点筛查和临床干预。

Abstract:
Objective To explore the risk factors of hospital death of acute pulmonary embolism, and construct the prediction model.
Methods A total of 197 patients with acute pulmonary embolism were selected from the emergency department. Thirty-seven patients who died in hospital and other 160 patients were divided into the death group and survival group, respectively. The general data and related clinical indicators of two groups were collected, and analysed using the univariate analysis and multivariate logistic regression analysis to construct the prediction model.
Results The results of the univariate analysis showed that the didfferences of the systolic blood pressure, chest tightness, syncope, electrolyte disturbance, hypertension, diabetes, pH, partial pressure of oxygen, partial pressure of carbon dioxide, N-terminal B-type natriuretic peptide (NT-proBNP), lactic acid, high-sensitive cardiac troponin (hs-cTn), right atrial diameter, left ventricular ejection fraction (LVEF), anticoagulation and simplified pulmonary embolism score (sPESI) risk classification ≥1 were statistically significant between two groups (P ＜ 0.05 to P ＜ 0.01). The results of binary logistic regression analysis showed that the electrolyte disturbance, hypertension history, hypoxia partial pressure, high level of NT-proBNP, hs-cTn, low LVEF and sPESI risk classification ≥ 1 were the independent risk factors of hospital death of acute pulmonary embolism (P ＜ 0.05 to P ＜ 0.01). The prediction models showed that the Prob = 1/ (e^–Y), Y = 29.945 – 1.507* (electrolyte disturbance) – 0.089* (hypertension) + 3.324* (oxygen partial pressure) – 1.530* (NT-proBNP) – 0.086* (hs-cTn) + 0.594* (LVEF) – 0.862* (sP ESI risk stratification ≥ 1).
Conclusions The electrolyte disturbance, hypertension history, oxygen partial pressure, NT-proBNP, hs-cTn, LVEF and sPESI risk stratification were the independent influencing factors of in-hospital death of acute pulmonary embolism. The prediction model based on this method has good efficacy, which can help to predict the risk of hospital death of acute pulmonary embolism patients, and help medical staff to focus on screening and clinical intervention for high-risk patients.

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