非创伤性院外心脏骤停自主循环恢复患者继发心血管事件的预测模型

Predictive model for secondary cardiovascular events in patients with non-traumatic out-of-hospital cardiac arrest who achieve return of spontaneous

摘要:

目的 构建并验证用于预测非创伤性院外心脏骤停（OHCA）自主循环恢复（ROSC）患者继发心血管事件风险的列线图预测模型。方法 选取2019年1月—2024年1月丽水市人民医院收治的210例心肺复苏（CPR）后ROSC的OHCA患者。随访1个月，根据预后结果分为未发生心血管事件组22例和发生心血管事件组188例。回顾性分析两组患者的临床资料；采用多因素一般Logistic回归分析CPR后ROSC的OHCA患者继发心血管事件的危险因素，根据结果建立列线图预测模型，并采用校准曲线进行验证。结果 两组患者的查尔森合并症指数（WIC）评分、急性生理与慢性健康评估系统Ⅱ（APACHE Ⅱ）评分、急救反应时间、CPR时间、肾上腺素用量、救护车到达时长比较，差异均有统计学意义（P <0.05）。多因素一般Logistic回归分析结果显示，救护车到达时长久［O^R =16.608（95% CI：1.417，194.589）］、WIC评分高［O^R =8.319（95% CI：1.791，38.634）］、APACHE Ⅱ评分高［O^R =1.466（95% CI：1.064，2.020）］、急救反应时间长［O^R =1.756（95% CI：1.256，2.456）］、CPR时间长［O^R =2.555（95% CI：1.408，4.635）］、肾上腺素用量多［O^R =9.677（95% CI：2.216，42.268）］均是CPR后ROSC的OHCA患者继发心血管事件的危险因素（P <0.05）。根据多因素一般Logistic回归分析结果构建的列线图预测模型能有效预测CPR后ROSC的OHCA患者继发心血管事件的风险，校准曲线验证表明该模型具有良好的预测准确性。结论 WIC评分和APACHE Ⅱ评分高、急救反应时间和CPR时间长、救护车到达时长久、肾上腺素用量多是CPR后ROSC的OHCA患者继发心血管事件的危险因素。该模型具有良好的预测准确性，有助于识别高风险患者并采取相应的预防措施。

Abstract:

Objective To develop and validate a nomogram predictive model for assessing the risk of secondary cardiovascular events in patients who successfully achieve Return of Spontaneous Circulation (ROSC) following non-traumatic Out-of-Hospital Cardiac Arrest (OHCA).Methods This study included 210 patients who underwent cardiopulmonary resuscitation (CPR) and achieved ROSC after OHCA, treated at Lishui People's Hospital from January 2019 to January 2024. They were followed for one month and categorized into two groups based on the occurrence of cardiovascular events: 22 patients without events and 188 with events. A retrospective analysis was conducted on the general information and clinical indicators of two groups of patients. Through multifactorial logistic regression analysis, the risk factors for cardiovascular events in patients with ROSC after CPR for OHCA were identified. Based on these results, a nomogram predictive model was established and validated using a calibration curve.Results Univariate correlation analysis indicated significant differences between the two groups in Charlson Comorbidity Index (WIC) scores, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores, emergency response time, prehospital cardiopulmonary resuscitation (CPR) time, epinephrine dosage, and ambulance arrival time (P < 0.05). Multivariate logistic regression identified longer ambulance arrival times [O^R = 16.608 (95% CI: 1.417, 194.589)], high WIC scores [O^R = 8.319 (95% CI: 1.791, 38.634)], high APACHE Ⅱ scores [O^R = 1.466 (95% CI: 1.064, 2.020)], longer emergency response times [O^R = 1.756 (95% CI: 1.256, 2.456)], prehospital CPR duration [O^R = 2.555 (95% CI: 1.408, 4.635)], higher epinephrine dosages [O^R = 9.677 (95% CI: 2.216, 42.268)] as independent risk factors for secondary cardiovascular events in post-ROSC OHCA patients (P < 0.05). The developed nomogram prediction model effectively predicted cardiovascular events, and the calibration curve validation demonstrated good predictive accuracy.Conclusion WIC score, APACHE Ⅱ score, emergency response time, pre-hospital CPR duration, epinephrine dosage, and ambulance arrival time are independent risk factors for cardiovascular events in patients following non-traumatic OHCA who achieve ROSC. This model provides a valuable predictive tool for clinical use, aiding in the identification of high-risk patients and the implementation of appropriate preventative measures.