开发用于肺动脉内膜切除术风险评估的开源工具。

IF 16.6 1区 医学 Q1 RESPIRATORY SYSTEM
James Liley, Katherine Bunclark, Michael Newnham, John Cannon, Karen Sheares, Dolores Taboada, Choo Ng, Nicholas Screaton, David Jenkins, Joanna Pepke-Zaba, Mark Toshner
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引用次数: 0

摘要

背景:风险预测工具是心胸外科手术的常规工具,但尚未开发用于肺动脉内膜剥脱术(PEA)的工具。目前还没有数据显示接受肺动脉内膜剥脱术的患者是否能从定制的风险建模方法中获益。我们开发并验证了一种可用于临床的工具,用于预测 PEA 90 天死亡率(90 DM),其次是利用常见的临床评估参数,告知可能影响五年死亡率(5 YM)和患者报告结果(PROchange)改善的因素。得出的模型预测结果与目前最广泛使用的心胸外科风险工具 EuroSCORE II 的预测结果进行了比较:2007年至2018年期间因慢性血栓栓塞性肺动脉高压(CTEPH)接受PEA手术的连续患者(n=1334)被纳入发现数据集。结果预测因素包括一系列变量,包括人口统计学、功能和生理指标。每个结果都考虑了三个统计模型(线性回归、惩罚线性回归和随机森林),每个模型都通过交叉验证进行了校准、拟合和评估,以确保内部一致性。最佳预测模型被纳入开源PEA风险工具,并通过同一机构2019年至2021年的单独前瞻性PEA队列(n=443)进行验证:随机森林模型对所有三种结果的预测准确性最高。新型风险模型对结果90 DM的判别能力(AUROC 0.82)优于EuroSCORE II(AUROC 0.65)。CTEPH 相关因素对 90 DM 结果很重要,但 5 YM 则是由非 CTEPH 因素驱动的,主要是一般心血管风险。我们无法准确预测PRO状态的积极改善(AUROC 0.47):结论:PEA的手术死亡率可以在术前预测,其程度可能对临床有用。我们的验证模型可在临床医生护理点进行个体化风险分层,为共同决策提供更好的信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development of an open-source tool for risk assessment in pulmonary endarterectomy.

Background: Risk prediction tools are routinely utilised in cardiothoracic surgery but have not been developed for pulmonary endarterectomy (PEA). There is no data on whether patients undergoing PEA may benefit from a tailored risk modelling approach. We develop and validate a clinically-usable tool to predict PEA 90-day mortality (90 DM) with the secondary aim of informing factors that may influence five-year mortality (5 YM) and improvement in patient-reported outcomes (PROchange) using common clinical assessment parameters. Derived model predictions were compared to those of the currently most widely implemented cardiothoracic surgery risk tool, EuroSCORE II.

Methods: Consecutive patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH) between 2007 and 2018 (n=1334) were included in a discovery dataset. Outcome predictors included an intentionally broad array of variables, incorporating demographic, functional and physiological measures. Three statistical models (linear regression, penalised linear regression and random forest) were considered per outcome, each calibrated, fitted and assessed using cross-validation, ensuring internal consistency. The best predictive models were incorporated into an open-source PEA risk tool and validated using a separate prospective PEA cohort from 2019 to 2021 (n=443) at the same institution.

Results: Random forest models had the greatest predictive accuracy for all three outcomes. Novel risk models had acceptable discriminatory ability for outcome 90 DM (AUROC 0.82) outperforming that of EuroSCORE II (AUROC 0.65). CTEPH related factors were important for outcome 90 DM but 5 YM was driven by non-CTEPH factors, dominated by generic cardiovascular risk. We were unable to accurately predict a positive improvement in PRO status (AUROC 0.47).

Conclusions: Operative mortality from PEA can be predicted pre-operatively to a potentially clinically useful degree. Our validated models enable individualised risk stratification at clinician point-of-care to better inform shared decision making.

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来源期刊
European Respiratory Journal
European Respiratory Journal 医学-呼吸系统
CiteScore
27.50
自引率
3.30%
发文量
345
审稿时长
2-4 weeks
期刊介绍: The European Respiratory Journal (ERJ) is the flagship journal of the European Respiratory Society. It has a current impact factor of 24.9. The journal covers various aspects of adult and paediatric respiratory medicine, including cell biology, epidemiology, immunology, oncology, pathophysiology, imaging, occupational medicine, intensive care, sleep medicine, and thoracic surgery. In addition to original research material, the ERJ publishes editorial commentaries, reviews, short research letters, and correspondence to the editor. The articles are published continuously and collected into 12 monthly issues in two volumes per year.
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