Based on Lasso-Cox regression to analyze influence factors of the staying time in ICU after heart valvular surgery

doi:10.3877/cma.j.issn.2096-1537.2022.02.006

Abstract

Abstract:

Objective

To analyze the factors affecting the ICU staying time after heart valve surgery by Lasso-Cox regression.

Methods

The clinical data of 930 consecutive cases of patients with heart valve surgery between January 2014 and December 2015 in our hospital were collected. Influence actors were filtered by the Lasso-Cox regression and two models were established: the Pre model (using preoperative influence factors) and the Pro model (using preoperative and intraoperative influence factors). The accuracy of the prediction of ICU staying time for both of the Pre and Pro models was assessed and compared by area under curve (AUC) of the receiver operating characteristic curve (ROC).

Results

The median staying time in ICU was 70.5 h. Influence factors of the Pre model were age, preoperative total bilirubin, preoperative hypertension, preoperative creatinine clearance, influence factors of the Pro model were age, preoperative total bilirubin, preoperative hypertension, preoperative creatinine clearance, preoperative red blood cell count, cardiopulmonary bypass time, aortic cross clamp time, tricuspid valve replacement. The AUCs of the Pre model at 24 h, 48 h and 72 h transferring from ICU were 0.6144 (95%CI: 0.5684-0.6611), 0.6543 (95%CI: 0.6251-0.7056), 0.6657 (95%CI: 0.6203-0.7056), the AUCs of the Pro model at 24 h, 48 h and 72 h transferring from ICU were 0.7021 (95% CI: 0.6622-0.7403), 0.7123 (95% CI: 0.6690-0.7442), 0.7424 (95% CI: 0.7128-0.7833).

Conclusions

Influence factors of the ICU staying time after heart valve surgery are age, preoperative total bilirubin, preoperative hypertension, preoperative creatinine clearance, preoperative red blood cell count, cardiopulmonary bypass time, aortic cross clamp time, tricuspid valve replacement. Adding the intraoperative influence factors can increase the accuracy of the prediction of ICU staying time after heart valvular surgery.

Key words: Intensive care unit staying time, Risk model, Heart valvular surgery

Cuiping Wang, Baiyun Tang, Yunqi Liu, Bao Zhang, Xiangdong Guan. Based on Lasso-Cox regression to analyze influence factors of the staying time in ICU after heart valvular surgery[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(02): 116-120.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2022.02.006

https://icu.cma-cmc.com.cn/EN/Y2022/V08/I02/116

Figures/Tables 4

资料	结果	资料	结果
基本信息		纤维蛋白原（g/L）	3.08±1.16
年龄（岁， $x ¯$ ±s）	47.91±13.83	术前血肌酐（μmol/L）	77.19±27.07
女性［例（%）］	485（52.15）	尿素氮（mmol/L）	6.12±2.50
身高（cm， $x ¯$ ±s）	160.73±8.18	尿酸（μmol/L）	374.78±122.51
体质量（kg， $x ¯$ ±s）	54.66±10.39	红细胞沉降率（mm/h）	23.49±20.45
体质量指数（kg/m²， $x ¯$ ±s）	21.08±3.29	术前肌酐清除率（ml/min）	79.62±34.28
体表面积（m²， $x ¯$ ±s）	1.24±0.67	术前肌酐清除率分布［例（%）］
并发症或合并症［例（%）］		≤50 ml/min	116（12.47）
4周内发生过心力衰竭	601（64.62）	51~70 ml/min	396（42.58）
感染性心内膜炎	88（9.46）	＞70 ml/min	418（44.95）
合并2型糖尿病	48（5.16）	术前超声心动图信息（ $x ¯$ ±s）
合并高血压病	122（13.12）	左心室射血分数（%）	62.71±10.14
合并慢性肺疾病	78（8.39）	左心室舒张末期内径（mm）	54.51±11.10
合并慢性肝病	78（8.39）	肺动脉收缩压（mmHg）	21.86±27.54
术前房颤律	389（41.83）	术中体外循环时间（min， $x ¯$ ±s）	117.93±58.20
再次手术［例（%）］	58（6.24）	主动脉阻断时间（min， $x ¯$ ±s）	80.23±34.70
术前实验室检验（ $x ¯$ ±s）		辅助循环时间（min， $x ¯$ ±s）	37.70±22.50
白细胞计数（×10⁹/L）	7.04±2.46	手术类型［例（%）］
红细胞计数（×10¹²/L）	4.68±0.70	主动脉瓣置换术	92（9.89）
血红蛋白浓度（g/L）	133.78±19.63	二尖瓣置换术	177（19.03）
血小板计数（×10⁹/L）	213.26±66.44	二尖瓣成形术	57（6.13）
红细胞分布宽度（%）	14.00±2.00	三尖瓣置换术	33（3.55）
丙氨酸氨基转移酶（U/L）	25.79±33.60	联合瓣膜手术	452（48.60）
白蛋白（g/L）	42.29±18.01	瓣膜手术联合冠状动脉旁路移植术	28（3.01）
术前总胆红素（μmol/L）	15.88±10.39	瓣膜手术联合射频消融术	27（2.91）
部分凝血酶原时间（s）	29.30±5.72	瓣膜手术联合其他手术	64（6.88）

资料	结果	资料	结果
基本信息		纤维蛋白原（g/L）	3.08±1.16
年龄（岁， $x ¯$ ±s）	47.91±13.83	术前血肌酐（μmol/L）	77.19±27.07
女性［例（%）］	485（52.15）	尿素氮（mmol/L）	6.12±2.50
身高（cm， $x ¯$ ±s）	160.73±8.18	尿酸（μmol/L）	374.78±122.51
体质量（kg， $x ¯$ ±s）	54.66±10.39	红细胞沉降率（mm/h）	23.49±20.45
体质量指数（kg/m²， $x ¯$ ±s）	21.08±3.29	术前肌酐清除率（ml/min）	79.62±34.28
体表面积（m²， $x ¯$ ±s）	1.24±0.67	术前肌酐清除率分布［例（%）］
并发症或合并症［例（%）］		≤50 ml/min	116（12.47）
4周内发生过心力衰竭	601（64.62）	51~70 ml/min	396（42.58）
感染性心内膜炎	88（9.46）	＞70 ml/min	418（44.95）
合并2型糖尿病	48（5.16）	术前超声心动图信息（ $x ¯$ ±s）
合并高血压病	122（13.12）	左心室射血分数（%）	62.71±10.14
合并慢性肺疾病	78（8.39）	左心室舒张末期内径（mm）	54.51±11.10
合并慢性肝病	78（8.39）	肺动脉收缩压（mmHg）	21.86±27.54
术前房颤律	389（41.83）	术中体外循环时间（min， $x ¯$ ±s）	117.93±58.20
再次手术［例（%）］	58（6.24）	主动脉阻断时间（min， $x ¯$ ±s）	80.23±34.70
术前实验室检验（ $x ¯$ ±s）		辅助循环时间（min， $x ¯$ ±s）	37.70±22.50
白细胞计数（×10⁹/L）	7.04±2.46	手术类型［例（%）］
红细胞计数（×10¹²/L）	4.68±0.70	主动脉瓣置换术	92（9.89）
血红蛋白浓度（g/L）	133.78±19.63	二尖瓣置换术	177（19.03）
血小板计数（×10⁹/L）	213.26±66.44	二尖瓣成形术	57（6.13）
红细胞分布宽度（%）	14.00±2.00	三尖瓣置换术	33（3.55）
丙氨酸氨基转移酶（U/L）	25.79±33.60	联合瓣膜手术	452（48.60）
白蛋白（g/L）	42.29±18.01	瓣膜手术联合冠状动脉旁路移植术	28（3.01）
术前总胆红素（μmol/L）	15.88±10.39	瓣膜手术联合射频消融术	27（2.91）
部分凝血酶原时间（s）	29.30±5.72	瓣膜手术联合其他手术	64（6.88）

变量	Pre模型（930例）			Pro模型（930例）
变量	系数	exp（coef）	P值	系数	exp（coef）	P值
年龄	-0.1078	0.8978	0.0058	-0.1072	0.8984	0.0072
术前总胆红素	-0.1285	0.8795	0.0002	-0.1226	0.8846	0.0004
高血压病	-0.2560	0.7741	0.0145	-0.2920	0.7468	0.0054
术前肌酐清除率	0.1204	1.1279	0.0401	0.1037	1.1092	0.0079
术前RBC	-	-	-	0.0828	1.0863	0.0188
体外循环时间	-	-	-	-0.1885	0.8282	＜0.01
主动脉阻断时间	-	-	-	-0.1423	0.8674	0.0014
三尖瓣置换术	-	-	-	-0.6334	0.5308	0.0015

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