Logistic Risk Model for Prolonged Ventilation After Adult Cardiac Surgery
| Autor: | D. Mark Pullan, Shekar L.C. Reddy, Elaine M. Griffiths, Abbas Rashid, Antony D. Grayson |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Multivariate statistics Heart Diseases Logistic regression Risk Assessment Body Mass Index law.invention Postoperative Complications law Internal medicine medicine Humans Cardiac Surgical Procedures Risk factor Aged Retrospective Studies Aged 80 and over Models Statistical Receiver operating characteristic business.industry Retrospective cohort study Middle Aged Respiration Artificial Surgery Cardiac surgery Organization and Administration Ventilation (architecture) Cardiology Female Cardiology and Cardiovascular Medicine business Risk assessment |
| Zdroj: | The Annals of Thoracic Surgery. 84:528-536 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2007.04.002 |
| Popis: | The aim of this study was to develop a multivariate risk prediction model for prolonged ventilation after adult cardiac surgery.This is a retrospective analysis of prospectively collected data on 12,662 consecutive patients undergoing adult cardiac surgery between April 1997 and March 2005. Data were randomly split into a development dataset (n = 6,000) and a validation dataset (n = 6,662). A multivariate logistic regression analysis was undertaken using a forward stepwise technique to identify independent risk factors for prolonged ventilation (defined as ventilation greater than 48 hours). The area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness-of-fit statistic were calculated to assess the performance and calibration of the model, respectively. Patients were split into low-, medium-, and high-risk groups based on their predicted probability of prolonged ventilation.Three hundred thirty-three patients had prolonged ventilation (5.5%). Independent variables, identified with prolonged ventilation, are shown with relevant coefficient values and p values as follows: (1) age 65 to 75 years, 0.7831, p0.001; (2) age 75 to 80 years, 1.5605, p0.001; (3) age greater than 80 years, 1.7115, p0.001; (4) forced expiratory volume less than 70% predicted, 0.3707, p = 0.013; (5) current smoker, 0.5315, p = 0.001; (6) serum creatinine 125 to 175 micromol/L, 0.6371, p0.001; (7) serum creatinine greater than 175 micromol/L, 1.3817, p0.001; (8) peripheral vascular disease, 0.6212, p0.001; (9) ejection fraction less than 0.30, 0.7839, p0.001; (10) myocardial infraction less than 90 days, 0.7415, p0.001; (11) preoperative ventilation, 1.3540, p = 0.004; (12) prior cardiac surgery, 0.8946, p0.001; (13) urgent surgery, 0.4414, p = 0.004; (14) emergency surgery, 0.7421, p = 0.005; (15) mitral valve surgery, 0.7715, p0.001; (16) aortic surgery, 1.7043, p0.001; and (17) use of cardiopulmonary bypass, 0.4052, p = 0.025; intercept, -4.7666. The ROC curve for the predicted probability of prolonged ventilation was 0.79, indicating a good discrimination power. The prediction equation was well-calibrated, predicting well at all levels of risk. A simplified additive scoring system was also developed. In the validation dataset, 5.1% of patients had prolonged ventilation compared with 5.4% expected. The ROC curve for the validation dataset was 0.75.We developed a contemporaneous multivariate prediction model for prolonged ventilation after cardiac surgery. This tool can be used in day-to-day practice to calculate patient-specific risk by the logistic equation or a simple scoring system with an equivalent predicted risk. |
| Databáze: | OpenAIRE |
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