糖尿病可预测主动脉弓置换术后的严重呼吸衰竭

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ivancarmine Gambardella, Berhane Worku, Christopher Lau, Robert Tranbaugh, Sandhya Balaram, Leonard Girardi
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引用次数: 0

摘要

目的:肺是糖尿病(DM)通过肺弹性蛋白和胶原蛋白糖化作用的靶器官。此外,高血糖会导致高碳酸血症性呼吸衰竭,而低碳水化合物高脂(LC-HL)营养可减轻这种情况。我们试图确定糖尿病与开腹主动脉弓置换术(AAR)后严重呼吸衰竭(SRF,即需要再次插管/气管造口术)之间的关系。 方法:评估机器学习算法预测SRF的精确度和召回率(F2得分)以及临床适用性。条件回归评估了 1:2 倾向分数匹配后 SRF 的独立预测因素。 结果1275名接受AAR治疗的患者(1997-2023年)的糖尿病状态信息可用。虽然支持向量机的 F2 得分最高(F2 = 0.337),但条件推理树提供了最适用于临床的算法:糖尿病是 SRF 的最佳预测因素,20/150 例糖尿病患者(13.3%)与 40/1125 例非糖尿病患者(3.6%)中都出现了 SRF(p <0.01)。在糖尿病患者中,左心室射血分数(LVEF)是 SRF 的次佳预测指标,LVEF ≤ 30% 的糖尿病患者有 8/20 例(40%),而 LVEF ≥gt;30% 的糖尿病患者有 12/130 例(9.2%)(P = 0.02)。在非糖尿病患者中,慢性阻塞性肺病(COPD)是预测呼吸衰竭的次佳指标,有 COPD 的非糖尿病患者有 14/177 例(7.9%),无 COPD 的非糖尿病患者有 26/948 例(2.7%)(P = 0.01)。在匹配样本中,糖尿病可独立预测 SRF(OR 2.20,95% CI 1.10 | 4.42)。 结论:糖尿病是 SRF 的最佳预测因素:糖尿病是 AAR 后 SRF 的最佳预测因素。应将严格控制血糖和低密度脂蛋白-高密度脂蛋白营养作为减少糖尿病患者术后 SRF 的措施进行评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Diabetes Mellitus Predicts Severe Respiratory Failure After Aortic Arch Replacement

Diabetes Mellitus Predicts Severe Respiratory Failure After Aortic Arch Replacement

Objective: The lung is a target organ of diabetes mellitus (DM) via glycation of pulmonary elastin and collagen. In addition, hyperglycemia facilitates hypercapnic respiratory failure, which is instead mitigated by low-carbohydrate high-lipid (LC-HL) nutrition. We sought to determine the association between diabetes and severe respiratory failure (SRF, i.e., need of reintubation\tracheostomy) after open aortic arch replacement (AAR).

Methods: Machine learning algorithms were evaluated for precision and recall (F2 score) and for clinical applicability to predict SRF. Conditional regression evaluated independent predictors of SRF after 1:2 propensity-score matching.

Results: Information on diabetic status was available in 1275 patients undergoing AAR (1997–2023). Although support vector machine presented the highest F2 score (F2 = 0.337), conditional inference trees provided the most clinically applicable algorithm: diabetes was the best predictor of SRF, which occurred in 20/150 diabetics (13.3%) vs. 40/1125 nondiabetics (3.6%) (p < 0.01). In diabetics, left ventricular ejection fraction (LVEF) was the next best predictor of SRF, which occurred in 8/20 diabetics with LVEF ≤ 30% (40%) vs. 12/130 diabetics with LVEF >30% (9.2%) (p = 0.02). In nondiabetics, chronic obstructive pulmonary disease (COPD) was the next best predictor of respiratory failure, which occurred in 14/177 nondiabetics with COPD (7.9%) vs. 26/948 nondiabetics without COPD (2.7%) (p = 0.01). In the matched sample, diabetes was independently able to predict SRF (OR 2.20, 95% CI 1.10 | 4.42).

Conclusions: DM was the best predictor of SRF after AAR. Strict glycemic control and LC-HL nutrition should be evaluated as measures to reduce postoperative SRF in diabetic patients.

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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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