背景:相当一部分急性中毒患者存在意识障碍。及早发现那些需要高级医疗护理的病人,如机械通气(MV),可以改善其预后。
方法:这项研究包括330名意识受损并进入坦塔大学毒物控制中心的急性中毒患者,埃及,在2021年1月至2023年12月期间。患者被纳入衍生(257名患者)和验证(73名患者)队列。分析患者数据以开发和验证预测列线图,以确定急性中毒患者需要MV的可能性。
结果:MV需求的重要预测因子是平均动脉血压(OR=0.96,p=0.014),PaO2(OR=0.96,p=.001),pH值(OR=0.00,p<。001),和葡萄糖/钾比率(OR=1.59,p=0.030)。这四个参数用于制定床边列线图。对建议的列线图的接收器工作特性(ROC)分析表明,曲线下面积(AUC)=95.7%,准确度=93.4%,灵敏度=88.9%,特异性=95.1%。使用自举方法和校准曲线评估开发的列线图的内部验证。关于外部验证,开发的列线图概率的AUC为96.5%,使用开发的列线图预测概率为97.8%。
结论:本研究提供了一个经过验证的列线图,可作为一种可靠的工具,用于准确预测意识障碍的急性中毒患者的MV需求。它可以帮助早期识别需要MV的患者,特别是在资源有限的低收入国家。
BACKGROUND: A considerable portion of acutely intoxicated patients is presented with impaired consciousness. Early identification of those patients who require advanced medical care, such as mechanical ventilation (MV), can improve their prognosis.
METHODS: This study included 330 acutely intoxicated patients who were presented with impaired consciousness and admitted to Tanta University Poison Control Center, Egypt, in the period from January 2021 to December 2023. Patients were enrolled in derivation (257 patients) and validation (73 patients) cohorts. Patients\' data were analyzed to develop and validate a predictive nomogram to determine the probability of MV need in acutely intoxicated patients.
RESULTS: Significant predictors for MV need were mean arterial blood pressure (OR = 0.96, p = .014), PaO2 (OR = 0.96, p = .001), pH (OR = 0.00, p < . 001), and glucose/potassium ratio (OR = 1.59, p = .030). These four parameters were used to formulate a bedside nomogram. Receiver-operating characteristic (ROC) analysis for the proposed nomogram shows that area under the curve (AUC) = 95.7%, accuracy = 93.4%, sensitivity = 88.9%, and specificity = 95.1%. The internal validation for the developed nomogram was assessed using a bootstrapping method and calibration curve. Regarding external validation, AUCs for the developed nomogram probability was 96.5%, and for predicted probability using the developed nomogram was 97.8%.
CONCLUSIONS: The current study provides a validated nomogram that could be used as a reliable tool for the accurate prediction of MV need among acutely intoxicated patients with impaired consciousness. It could assist in the early identification of patients who will require MV, especially in low-income countries with limited resources.