背景:已经发表了几种院内心脏骤停(IHCA)后生存的预测模型,但没有模型性能和外部验证的概述。我们使用停搏前因素对IHCA尝试复苏的结果预测的可用预后模型进行了系统评价,以通过改善的结果预测来增强临床决策。
方法:本系统综述遵循CHARMS和PRISMA指南。Medline,Embase,截至2021年10月,搜索了WebofScience。研究发展,纳入了针对IHCA尝试复苏的任何潜在临床结局更新或验证具有停搏前因素的预测模型.根据PROBAST检查表对研究进行了严格评估。进行随机效应荟萃分析以汇集外部验证模型的AUROC值。
结果:在筛选的2678篇初始文章中,这项系统评价包括33项研究:16项模型开发研究,5项模型更新研究和12项模型验证研究。最常见的逮捕前因素包括年龄,功能状态,(转移性)恶性肿瘤,心脏病,脑血管事件,呼吸,肾或肝功能不全,低血压和败血症。只有六个开发的模型在外部人群中得到了独立验证。GO-FAR评分表现最佳,合并AUROC为0.78(95%CI0.69-0.85),PAM的0.59(95CI0.50-0.68)和PAR的0.62(95%CI0.49-0.74)。
结论:已经发表了几种用于IHCA尝试复苏后临床结果的预后模型。大多数都有中等程度的偏差风险,没有经过外部验证。GO-FAR评分显示出最可接受的性能。未来的研究应该集中在更新现有的模型,用于临床设置,特别是逮捕前的咨询。系统审查注册PROSPEROCRD42021269235。2021年7月21日注册。
Several prediction models of survival after in-hospital cardiac arrest (IHCA) have been published, but no overview of model performance and external validation exists. We performed a systematic
review of the available prognostic models for outcome prediction of attempted resuscitation for IHCA using pre-arrest factors to enhance clinical decision-making through improved outcome prediction.
This systematic
review followed the CHARMS and PRISMA guidelines. Medline, Embase, Web of Science were searched up to October 2021. Studies developing, updating or validating a prediction model with pre-arrest factors for any potential clinical outcome of attempted resuscitation for IHCA were included. Studies were appraised critically according to the PROBAST checklist. A random-effects meta-analysis was performed to pool AUROC values of externally validated models.
Out of 2678 initial articles screened, 33 studies were included in this systematic
review: 16 model development studies, 5 model updating studies and 12 model validation studies. The most frequently included pre-arrest factors included age, functional status, (metastatic) malignancy, heart disease, cerebrovascular events, respiratory, renal or hepatic insufficiency, hypotension and sepsis. Only six of the developed models have been independently validated in external populations. The GO-FAR score showed the best performance with a pooled AUROC of 0.78 (95% CI 0.69-0.85), versus 0.59 (95%CI 0.50-0.68) for the PAM and 0.62 (95% CI 0.49-0.74) for the PAR.
Several prognostic models for clinical outcome after attempted resuscitation for IHCA have been published. Most have a moderate risk of bias and have not been validated externally. The GO-FAR score showed the most acceptable performance. Future research should focus on updating existing models for use in clinical settings, specifically pre-arrest counselling. Systematic
review registration PROSPERO CRD42021269235. Registered 21 July 2021.