经皮冠状动脉介入治疗后的抽血、输液和出血事件。

Meghana Iyer, Ankur Kalra, Khaled Ziada, Jacqueline Tamis-Holland, Leslie Cho, Rishi Puri, Stephen G Ellis, Umesh N Khot, Amar Krishnaswamy, Samir Kapadia, Grant W Reed
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引用次数: 0

摘要

背景:美国心脏病学会(ACC)国家心血管数据登记处(NCDR) CathPCI登记处报告经皮冠状动脉介入治疗(PCI) 72小时内出血事件作为质量指标。NCDR PCI后出血事件可能受到与PCI质量无关的患者护理强度标记物的影响。医源性静脉切开术、静脉输液与pci术后出血事件之间的关系尚不清楚。方法:这是一项患者水平的观察性研究,在2009年6月11日至2017年6月14日期间在单个中心进行了13,553例PCI手术。多变量logistic回归确定了NCDR出血事件、口服和静脉总液体输入量以及PCI当日至PCI后72小时抽出的实验室管数之间的关系。将这些变量加入出血风险模型后,判别能力的提高用c统计量进行评估。结果:出血767例(5.7%)。每输入100 mL与出血几率增加2.0%独立相关(比值比[OR] 1.01-1.03, p)。结论:反映患者疾病强度的变量,包括实验室抽血频率和PCI术后72小时内的液体摄入量,显著提高了模型预测NCDR PCI后出血事件的能力。在全国报告出血事件发生率时,应考虑对实验室抽血和液体管理进行风险调整。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Blood Draws, Fluid Input, and Bleeding Events After Percutaneous Coronary Intervention.

Background: The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry reports bleeding events within 72-h of percutaneous coronary intervention (PCI) as a quality metric. It is plausible that NCDR post-PCI bleeding events may be influenced by markers of intensity of patient care not related to PCI quality. The relationship between iatrogenic phlebotomy, intravenous fluid input, and post-PCI bleeding events is unknown.

Methods: This is a patient-level, observational study of 13,553 PCI procedures at a single center between 6/11/2009 and 6/14/2017. Multivariable logistic regression determined associations between NCDR bleeding events, total oral and intravenous fluid volume input, and number of lab tubes drawn on day of PCI up to 72-h post PCI. Improvement in discriminatory ability of adding these variables to a bleeding risk model was assessed with C-statistic.

Results: There were 767 (5.7%) bleeding events. Every 100 mL input was independently associated with 2.0% increased odds of bleeding (odds ratio [OR] 1.01-1.03, p < 0.001). Every 3 mL lab tube drawn was independently associated with 8.1% increased odds (OR 1.07-1.09, p < 0.001). A multivariable model including baseline patient characteristics and PCI variables achieved good discriminatory ability (C-statistic 0.858), but with addition of input, number of lab draws, and length of stay (LOS) achieved an excellent discriminatory ability (C-statistic 0.927, p < 0.001 comparing C-statistics).

Conclusions: Variables reflecting intensity of patient illness including frequency of lab draws and fluid intake within 72-h of PCI significantly improve the ability of models to predict NCDR post-PCI bleeding events. Consideration should be given to risk-adjusting for lab draws and fluid administration when nationally reporting bleeding event rates.

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