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Abstract：
BACKGROUND: Early extubation (EEx) is defined as the removal of the endotracheal tube within 8 h postoperatively. The present study involved determining the availability and threshold of the vasoactive-inotropic score (VIS) for predicting EEx in adults after elective rheumatic heart valve surgery.
METHODS: The present study was designed as a single-center retrospective cohort study which was conducted with adults who underwent elective rheumatic heart valve surgery with CPB. The highest VIS in the immediate postoperative period was used in the present study. The primary outcome, the availability of VIS for EEx prediction and the optimal threshold value were determined using ROC curve analysis. The gray zone analysis of the VIS was performed by setting the false negative or positive rate R = 0.05, and the perioperative risk factors for prolonged EEx were identified by multivariate logistic analysis. The postoperative complications and outcomes were compared between different VIS groups.
RESULTS: Among the 409 patients initially screened, 379 patients were ultimately included in the study. The incidence of EEx was determined to be 112/379 (29.6%). The VIS had a good predictive value for EEx (AUC = 0.864, 95% CI: [0.828, 0.900], P < 0.001). The optimal VIS threshold for EEx prediction was 16.5, with a sensitivity of 71.54% (65.85-76.61%) and a specificity of 88.39% (81.15-93.09%). The upper and lower limits of the gray zone for the VIS were determined as (12, 17.2). The multivariate logistic analysis identified age (OR, 1.060; 95% CI: 1.017-1.106; P = 0.006), EF% (OR, 0.798; 95% CI: 0.742-0.859; P < 0.001), GFR (OR, 0.933; 95% CI: 0.906-0.961; P < 0.001), multiple valves surgery (OR, 4.587; 95% CI: 1.398-15.056; P = 0.012), and VIS > 16.5 (OR, 12.331; 95% CI: 5.015-30.318; P < 0.001) as the independent risk factors for the prolongation of EEx. The VIS ≤ 16.5 group presented a greater success rate for EEx, a shorter invasive ventilation support duration, and a lower incidence of complications than did the VIS > 16.5 group, while the incidence of reintubation was similar between the two groups.
CONCLUSIONS: In adults, after elective rheumatic heart valve surgery, the highest VIS in the immediate postoperative period was a good predictive value for EEx, with a threshold of 16.5.
METHODS: The present study was designed as a single-center retrospective cohort study which was conducted with adults who underwent elective rheumatic heart valve surgery with CPB. The highest VIS in the immediate postoperative period was used in the present study. The primary outcome, the availability of VIS for EEx prediction and the optimal threshold value were determined using ROC curve analysis. The gray zone analysis of the VIS was performed by setting the false negative or positive rate R = 0.05, and the perioperative risk factors for prolonged EEx were identified by multivariate logistic analysis. The postoperative complications and outcomes were compared between different VIS groups.
RESULTS: Among the 409 patients initially screened, 379 patients were ultimately included in the study. The incidence of EEx was determined to be 112/379 (29.6%). The VIS had a good predictive value for EEx (AUC = 0.864, 95% CI: [0.828, 0.900], P < 0.001). The optimal VIS threshold for EEx prediction was 16.5, with a sensitivity of 71.54% (65.85-76.61%) and a specificity of 88.39% (81.15-93.09%). The upper and lower limits of the gray zone for the VIS were determined as (12, 17.2). The multivariate logistic analysis identified age (OR, 1.060; 95% CI: 1.017-1.106; P = 0.006), EF% (OR, 0.798; 95% CI: 0.742-0.859; P < 0.001), GFR (OR, 0.933; 95% CI: 0.906-0.961; P < 0.001), multiple valves surgery (OR, 4.587; 95% CI: 1.398-15.056; P = 0.012), and VIS > 16.5 (OR, 12.331; 95% CI: 5.015-30.318; P < 0.001) as the independent risk factors for the prolongation of EEx. The VIS ≤ 16.5 group presented a greater success rate for EEx, a shorter invasive ventilation support duration, and a lower incidence of complications than did the VIS > 16.5 group, while the incidence of reintubation was similar between the two groups.
CONCLUSIONS: In adults, after elective rheumatic heart valve surgery, the highest VIS in the immediate postoperative period was a good predictive value for EEx, with a threshold of 16.5.
摘要：
背景：早期拔管（EEx）定义为术后8小时内拔除气管导管。本研究涉及确定血管活性肌力评分（VIS）的可用性和阈值，以预测选择性风湿性心脏瓣膜手术后成人的EEx。
方法：本研究设计为一项单中心回顾性队列研究，对接受CPB选择性风湿性心脏瓣膜手术的成年人进行。本研究使用术后即刻最高的VIS。主要结果，使用ROC曲线分析确定用于EEx预测的VIS的可用性和最佳阈值。通过设置假阴性或假阳性率R=0.05进行VIS的灰色地带分析，并通过多因素logistic分析确定围手术期EEx延长的危险因素。比较不同VIS组术后并发症及预后。
结果：在最初筛查的409名患者中，最终将379名患者纳入研究。EEx的发生率确定为112/379(29.6%)。VIS对EEx具有良好的预测价值(AUC=0.864，95%CI：[0.828，0.900]，P<0.001)。EEx预测的最佳VIS阈值为16.5，敏感性为71.54％（65.85-76.61％），特异性为88.39％（81.15-93.09％）。确定VIS的灰色区域的上限和下限为(12,17.2)。多变量逻辑分析确定的年龄(OR，1.060；95%CI：1.017-1.106；P=0.006），EF%(OR，0.798；95%CI：0.742-0.859；P<0.001），GFR(或,0.933；95%CI：0.906-0.961；P<0.001），多瓣膜手术（或，4.587；95%CI：1.398-15.056；P=0.012），和VIS>16.5(或，12.331;95%CI:5.015-30.318;P<0.001)为EEx延长的独立危险因素。VIS≤16.5组的EEx成功率更高，更短的有创通气支持持续时间，且并发症发生率低于VIS>16.5组，而两组再插管的发生率相似。
结论：在成年人中，在选择性风湿性心脏瓣膜手术后，术后即刻最高的VIS是EEx的良好预测价值，门槛为16.5。
方法：本研究设计为一项单中心回顾性队列研究，对接受CPB选择性风湿性心脏瓣膜手术的成年人进行。本研究使用术后即刻最高的VIS。主要结果，使用ROC曲线分析确定用于EEx预测的VIS的可用性和最佳阈值。通过设置假阴性或假阳性率R=0.05进行VIS的灰色地带分析，并通过多因素logistic分析确定围手术期EEx延长的危险因素。比较不同VIS组术后并发症及预后。
结果：在最初筛查的409名患者中，最终将379名患者纳入研究。EEx的发生率确定为112/379(29.6%)。VIS对EEx具有良好的预测价值(AUC=0.864，95%CI：[0.828，0.900]，P<0.001)。EEx预测的最佳VIS阈值为16.5，敏感性为71.54％（65.85-76.61％），特异性为88.39％（81.15-93.09％）。确定VIS的灰色区域的上限和下限为(12,17.2)。多变量逻辑分析确定的年龄(OR，1.060；95%CI：1.017-1.106；P=0.006），EF%(OR，0.798；95%CI：0.742-0.859；P<0.001），GFR(或,0.933；95%CI：0.906-0.961；P<0.001），多瓣膜手术（或，4.587；95%CI：1.398-15.056；P=0.012），和VIS>16.5(或，12.331;95%CI:5.015-30.318;P<0.001)为EEx延长的独立危险因素。VIS≤16.5组的EEx成功率更高，更短的有创通气支持持续时间，且并发症发生率低于VIS>16.5组，而两组再插管的发生率相似。
结论：在成年人中，在选择性风湿性心脏瓣膜手术后，术后即刻最高的VIS是EEx的良好预测价值，门槛为16.5。
