年龄联合查尔森合并症指数预测急性冠状动脉综合征患者心搏骤停预后的研究

Value of age-combined Charlson co-morbidity index in predicting the prognosis of in-hospital cardiac arrest in patients with acute coronary syndrome

摘要:

目的：探讨年龄联合查尔森合并症指数（age-combined Charlson co-morbidity index，ACCI）对急性冠状动脉综合征（acute coronary syndrome，ACS）发生院内心搏骤停患者预后的预测效能，以期为临床预后的判断提供参考依据。方法：采取病例分析的方法，选取福建省3所三级甲等医院发生院内心搏骤停的ACS患者，收集ACS患者的一般资料、发生心搏骤停前合并症情况及其预后等资料，计算ACCI得分情况，将其分为低危0~2分，中危3~5分，高危6~8分，极高危≥9分，并分析其对患者预后的预测效能。结果：共有320例发生院内心搏骤停的ACS患者纳入研究，存活出院率为21.2%，ACCI得分的中位数为5（4~7）分，ACCI在存活出院和发生院内死亡的患者之间差异具有统计学意义（P<0.001）。与低危组相比，中危组患者存活出院率的OR值为0.49（0.11~1.33），高危组为0.11（0.03~0.41），极高危组为0.15（0.30~0.77），差异均有统计学意义（均P<0.05）。CCI与年龄联合能增加受试者工作特征曲线下面积，从0.68增加到0.76，特异度从76%提高到85%。结论：ACCI的得分越高，发生心搏骤停的ACS患者预后越差，ＣＣＩ与年龄联合能提高其预测效能，提高灵敏度和特异度。

Abstract:

Objective：To investigate the predictive efficiency of age-combined Charlson co-morbidity index（ACCI） for the prognosis of in-hospital cardiac arrest（IHCA） in patients with acute coronary syndrome（ACS），and to provide some recommendations for prog－nostic evaluation in clinical practice. Methods：A case analysis was performed for ACS patients who experienced IHCA in three grade A tertiary hospitals in Fujian Province，China. The data on general information，comorbidities before IHCA，and prognosis were collected，and ACCI score was calculated，with 0-2 points as low risk，3-5 points as moderate risk，6-8 points as high risk，and ≥9 points as extremely high risk. The prediction efficiency of ACCI for patient prognosis was analyzed. Results：A total of 320 ACS patients who experienced IHCA were enrolled，with a hospital discharge rate of 21.2%. Median ACCI was 5（range 4-7），and there was a significant difference in ACCI between the survival group and the hospital death group（P<0.001）. Compared with the low-risk group，the moderate-risk，high-risk，and extremely high-risk groups had odds ratios for hospital discharge of 0.49（0.11-1.33），0.11（0.03-0.41）（P<0.05），and 0.15（0.30-0.77）（P<0.05），respectively. After being combined with age，Charlson co-morbidity index（CCI） had an increased area under the receiver operating characteristic curve（0.68 vs. 0.76） and an increased specificity（76% vs. 85%）. Conclusion：ACS patients with a higher ACCI tend to have poorer prognosis of IHCA. After being combined with age，CCI has im－proved predictive efficiency and increased sensitivity and speci－ficity.