开发并验证用于预测意识受损的急性中毒患者机械通气需求的提名图。

Heba Ibrahim Lashin, Fatma Gaber Sobeeh, Zahraa Khalifa Sobh
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引用次数: 0

摘要

背景:相当一部分急性中毒患者会出现意识障碍。及早发现需要机械通气(MV)等高级医疗护理的患者可以改善他们的预后:本研究包括 2021 年 1 月至 2023 年 12 月期间,埃及坦塔大学中毒控制中心收治的 330 名意识受损的急性中毒患者。患者分为衍生组(257 名)和验证组(73 名)。对患者的数据进行了分析,以开发和验证一个预测提名图,确定急性中毒患者需要进行中压治疗的概率:结果:平均动脉血压(OR = 0.96,p = .014)、PaO2(OR = 0.96,p = .001)、pH 值(OR = 0.00,p < .001)和葡萄糖/钾比率(OR = 1.59,p = .030)是需要使用 MV 的重要预测指标。这四个参数被用于制定床旁提名图。对所提出的提名图进行的接收方操作特征(ROC)分析表明,曲线下面积(AUC)= 95.7%,准确性= 93.4%,灵敏度= 88.9%,特异性= 95.1%。使用引导法和校准曲线对所开发的提名图进行了内部验证。在外部验证方面,已开发提名图概率的 AUC 为 96.5%,使用已开发提名图预测概率的 AUC 为 97.8%:本研究提供了一个经过验证的提名图,可作为准确预测意识受损的急性中毒患者是否需要使用 MV 的可靠工具。它有助于及早发现需要接受 MV 治疗的患者,尤其是在资源有限的低收入国家。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development and validation of a nomogram for predicting mechanical ventilation need among acutely intoxicated patients with impaired consciousness.

Background: A considerable portion of acutely intoxicated patients is presented with impaired consciousness. Early identification of those patients who require advanced medical care, such as mechanical ventilation (MV), can improve their prognosis.

Methods: This study included 330 acutely intoxicated patients who were presented with impaired consciousness and admitted to Tanta University Poison Control Center, Egypt, in the period from January 2021 to December 2023. Patients were enrolled in derivation (257 patients) and validation (73 patients) cohorts. Patients' data were analyzed to develop and validate a predictive nomogram to determine the probability of MV need in acutely intoxicated patients.

Results: Significant predictors for MV need were mean arterial blood pressure (OR = 0.96, p = .014), PaO2 (OR = 0.96, p = .001), pH (OR = 0.00, p < . 001), and glucose/potassium ratio (OR = 1.59, p = .030). These four parameters were used to formulate a bedside nomogram. Receiver-operating characteristic (ROC) analysis for the proposed nomogram shows that area under the curve (AUC) = 95.7%, accuracy = 93.4%, sensitivity = 88.9%, and specificity = 95.1%. The internal validation for the developed nomogram was assessed using a bootstrapping method and calibration curve. Regarding external validation, AUCs for the developed nomogram probability was 96.5%, and for predicted probability using the developed nomogram was 97.8%.

Conclusion: The current study provides a validated nomogram that could be used as a reliable tool for the accurate prediction of MV need among acutely intoxicated patients with impaired consciousness. It could assist in the early identification of patients who will require MV, especially in low-income countries with limited resources.

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