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2023 年第 6 期 第 18 卷

简化肺栓塞严重指数对急性肺血栓栓塞症合并心房颤动患者院内不良事件的预测价值

Predictive value of simplified pulmonary embolism severity index for in-hospital adverse events in patients with acute pulmonary thromboembolism and atrial fibrillation

作者:王增智1韩康宁2李杰1高杨1郭伟1谢江1刘双1

英文作者:Wang Zengzhi1 Han Kangning2 Li Jie1 Gao Yang1 Guo Wei1 Xie Jiang1 Liu Shuang1

单位:1首都医科大学附属北京安贞医院呼吸与危重症医学科,北京100029;2首都医科大学附属北京安贞医院心内12病房,北京100029

英文单位:1Department of Respiratory and Critical Care Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2the 12th Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词:急性肺血栓栓塞症;心房颤动;简化肺栓塞严重指数;预测价值

英文关键词:Acutepulmonarythromboembolism;Atrialfibrillation;Simplifiedpulmonaryembolismseverityindex;Predictivevalue

  • 摘要:
  • 目的  探讨简化肺栓塞严重指数(sPESI)对急性肺血栓栓塞症(APE)合并心房颤动患者院内不良事件的预测价值。方法  回顾性选取首都医科大学附属北京安贞医院2008年1月1日至2021年12月31日收治的APE合并心房颤动住院患者197例。绘制受试者工作特征(ROC)曲线,以最大约登指数确定预测发生院内不良事件的sPESI评分的最佳截断值,按此截断值将患者分为高评分组和低评分组;根据有无发生院内不良事件将患者分为不良事件组和无不良事件组。采用Logistic回归模型分析院内不良事件的预测因素。结果  ROC曲线分析结果显示,sPESI评分的最佳截断值为2分,据此将患者分为高评分组(≥2分,71例)和低评分组(<2分,126例)。共20例(10.2%)患者发生院内不良事件,据此将患者分为不良事件组(20例)和无不良事件组(177例)。高评分组院内总不良事件发生率高于低评分组[19.7%(14/71)比4.8%(6/126)](P=0.001)。不良事件组14 d内手术、14 d内制动、晕厥、心率≥110次/min、右心室功能不全比例、血乳酸、白细胞计数水平、sPESI评分均高于无不良事件组,收缩压和舒张压均低于无不良事件组(均P<0.05)。sPESI评分≥2分和14 d内制动是APE合并心房颤动患者院内不良事件的独立危险因素(均P<0.05)。结论  sPESI评分≥2分是APE合并心房颤动患者发生院内不良事件的独立危险因素。

  • Objective    To investigate the predictive value of simplified pulmonary embolism severity index (sPESI) for in-hospital adverse events in patients with acute pulmonary thromboembolism (APE) and atrial fibrillation. Methods  From January 1, 2008 to December 31, 2021, 197 patients with APE and atrial fibrillation admitted to Beijing Anzhen Hospital, Capital Medical University were selected retrospectively. Receiver operating characteristic (ROC) curve was mapped, and maximum Youden index was used to determine the optimal cut-off value of sPESI score to predict in-hospital adverse events. The patients were divided into high score group and low score group according to the cut-off value. According to in-hospital adverse events, patients were divided into adverse event group and non-adverse event group. Logistic regression model was used to analyze the predictive factors for in-hospital adverse events. Results  ROC curve analysis showed that the optimal cut-off value of sPESI score was 2, and patients were divided into high score group (≥2, 71 cases) and low score group(<2, 126 cases) according to this. There were totally 20 cases (10.2%) had in-hospital adverse events, and patients were divided into adverse event group (20 cases) and non-adverse event group (177 cases). Total incidence rate of in-hospital adverse events in high score group was higher than that in low score group [19.7%(14/71)vs 4.8%(6/126)](P=0.001). The proportions of operation within 14 d, braked within 14 d, syncope, heart rate≥110 times/min and right ventricular dysfunction, the levels blood lactate and white blood cell count and sPESI score in adverse event group were higher than those in non-adverse event group, and systolic blood pressure and diastolic blood pressure were lower than those in the non-adverse event group (all P<0.05). sPESI score ≥2 and braked within 14 d were independent risk factors of in-hospital adverse events in patients with APE and atrial fibrillation (both P<0.05). Conclusions  PESI score ≥2 is an independent risk factor of in-hospital adverse events in patients with APE and atrial fibrillation.

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