Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-10-01 Epub Date: 2024-03-21 DOI:10.1055/a-2292-0247
Francois Stephan, Mathilde Facque, Fares Ben Salem, Olivia Picq, Audrey Imbert, Thibaut Genty, Marc Zins
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引用次数: 0

Abstract

Background:  Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery.

Methods:  This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA).

Results:  The training cohort comprised 125 consecutive patients with suspected GIisch in 2008 to 2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure < 50 mm Hg, aspartate aminotransferase > 15 N, lactate increase in 24 hour > 20%, and 3 CTA findings, namely, bowel dilation, bowel wall thickening, and mesenteric vasoconstriction. The area under the receiver operating characteristic was 0.82 (95% confidence interval [CI], 0.51-0.93) in the training cohort and 0.82 (95% CI, 0.68-0.96) in the validation cohort (n = 34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤ 30% or ≥ 70%.

Conclusion:  In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population.

心胸外科手术后肠道缺血的概率预测。
背景:诊断心胸手术后患者的胃肠缺血(GIisch)具有挑战性。计算机断层扫描血管造影术(CTA)有很大的假阴性率和假阳性率。本研究的目的是评估综合利用现有变量是否能改善心胸手术后 GIisch 的诊断:这项回顾性研究包括心胸手术后接受重症监护的患者。GIisch由手术和/或内窥镜检查结果证实。使用 Spiegelhalter-Knill-Jones 系统在训练队列中制定了 GIisch 预测评分,然后在验证队列(CTA 无明显 GIisch 征象的患者)中进行测试:训练队列包括2008-2019年连续125例疑似GIisch患者,其中85例确诊为GIisch。92名患者进行了CTA检查,假阴性率较高,为17/60(28%),假阳性率较低,为7/32(22%)。该评分包括与 GIisch 呈负相关的心肺旁路和与 GIisch 呈正相关的六个变量:术中平均动脉压 15N、24 小时内乳酸增加 >20%,以及三个 CTA 发现,即肠管扩张、肠壁增厚和肠系膜血管收缩。训练队列的AUROC为0.82(95%CI,0.51-0.93),验证队列(34名患者)的AUROC为0.82(95%CI,0.68-0.96)。概率≤30%或≥70%时,预测概率的可靠性最高:结论:在心胸外科手术后接受重症监护的患者中,不能仅根据 CTA 结果排除 GIisch。将CTA检查结果与其他变量相结合的评分系统可提高对这类人群的GIisch诊断率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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