Establishment of a prediction model for death during hospitalization in patients with acute myocardial infarction

doi:10.3877/cma.j.issn.1674-6880.2023.02.005

Abstract

Abstract:

Objective

To identify the acute myocardial infarction patients with bad outcomes during hospitalization and to help clinical physicians to take intervention measures to reduce the mortality.

Methods

Clinical data were collected from 1 251 patients with acute myocardial infarction who were hospitalized in the Affiliated Dongyang Hospital of Wenzhou Medical University between 1st Jan 2013 and 31th May 2022. Independent risk factors of death during hospitalization were screened. Based on the screened variables, a nomogram prediction model was established. Then the model was evaluated for its prediction power by a receiver operating characteristic (ROC) curve, calibration accuracy by a GiViTI calibration curve and clinical effectiveness by decision curve analysis (DCA). Finally, the established prediction model was validated by a bootstrap assay.

Results

Stepwise regression analysis showed that age [odds ratio (OR) = 1.060, 95% confidence interval (CI) (1.035, 1.087), P < 0.001] and the maximum values of creatinine [OR = 1.003, 95%CI (1.001, 1.005), P = 0.012], lactic acid [OR = 1.190, 95%CI (1.064, 1.332), P = 0.002], creatine kinase isoenzymes [OR = 1.003, 95%CI (1.001, 1.004), P < 0.001], B-type natriuretic peptide precursor [OR = 1.006, 95%CI (1.004, 1.008), P < 0.001] and white blood cell [OR = 1.055, 95%CI (1.006, 1.105), P = 0.024] within 24 hours after hospitalization were significantly associated with death in hospital among patients with acute myocardial infarction. The area under the ROC curve of the prediction model was 0.851 (P < 0.001), with P value of 0.896, calibration slope of 1.000, R² of 0.328 and Brier scaled value of 0.055 in the calibration curve and with the DCA curve above the two extreme curves. In validation using bootstrap, the bias-corrected curve was closed to the idea curve.

Conclusions

Age and the maximum values of creatinine, lactic acid, creatine kinase isoenzymes, B-type natriuretic peptide precursor and white blood cell within 24 hours after hospitalization are independent risk factors of death in hospital among patients with acute myocardial infarction. The established model owns good prediction power for their death during hospitalization.

Key words: Myocardial infarction, Risk factor, Prediction model, Prognosis, Bootstrap, Nomogram, Stepwise regression analysis

Jian Ouyang, Jinqiao Li, Shuying Xu, Bin Wang, Jianping Chen. Establishment of a prediction model for death during hospitalization in patients with acute myocardial infarction[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(02): 116-122.

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Figures/Tables 6

References 26

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组别	例数	性别（例，男/女）	年龄（岁）	糖尿病[例（%）]	高血压[例（%）]	肌酐（μmol/L）	乳酸（mmol/L）	肌酸激酶同工酶（U/L）
存活组	1 154	832/322	71（60，80）	297（25.7）	701（60.7）	81（68，95）	1.8（1.3，2.7）	51（25，88）
死亡组	97	56/41	81（77，86）	27（27.8）	67（69.1）	106（87，224）	3.5（2.0，5.9）	69（32，236）
χ²/Z值		8.281	30 401.000	0.111	2.278	29 705.500	28 468.000	45 445.000
P值		0.004	< 0.001	0.740	0.131	< 0.001	< 0.001	0.002
组别	例数	AST（U/L）	行急诊PCI术[例（%）]	超敏C反应蛋白（mg/L）	肌钙蛋白T（μg/L）	B型脑钠肽前体（ng/L）	溶栓[例（%）]	白细胞计数（× 10⁹/L）
存活组	1 154	89（34，248）	625（54.2）	13（4，40）	1.6（0.3，4.2）	11.9（4.0，42.9）	35（3.0）	9.0（7.5，11.5）
死亡组	97	166（60，467）	28（28.9）	42（14，65）	2.0（0.3，6.0）	85.9（31.1，213.5）	4（4.1）	9.7（8.3，16.1）
χ²/Z值		43 175.000	21.940	35 585.000	50 883.000	25 082.000	-	42 984.000
P值		< 0.001	< 0.001	< 0.001	0.137	< 0.001	0.537	< 0.001

组别	例数	性别（例，男/女）	年龄（岁）	糖尿病[例（%）]	高血压[例（%）]	肌酐（μmol/L）	乳酸（mmol/L）	肌酸激酶同工酶（U/L）
存活组	1 154	832/322	71（60，80）	297（25.7）	701（60.7）	81（68，95）	1.8（1.3，2.7）	51（25，88）
死亡组	97	56/41	81（77，86）	27（27.8）	67（69.1）	106（87，224）	3.5（2.0，5.9）	69（32，236）
χ²/Z值		8.281	30 401.000	0.111	2.278	29 705.500	28 468.000	45 445.000
P值		0.004	< 0.001	0.740	0.131	< 0.001	< 0.001	0.002
组别	例数	AST（U/L）	行急诊PCI术[例（%）]	超敏C反应蛋白（mg/L）	肌钙蛋白T（μg/L）	B型脑钠肽前体（ng/L）	溶栓[例（%）]	白细胞计数（× 10⁹/L）
存活组	1 154	89（34，248）	625（54.2）	13（4，40）	1.6（0.3，4.2）	11.9（4.0，42.9）	35（3.0）	9.0（7.5，11.5）
死亡组	97	166（60，467）	28（28.9）	42（14，65）	2.0（0.3，6.0）	85.9（31.1，213.5）	4（4.1）	9.7（8.3，16.1）
χ²/Z值		43 175.000	21.940	35 585.000	50 883.000	25 082.000	-	42 984.000
P值		< 0.001	< 0.001	< 0.001	0.137	< 0.001	0.537	< 0.001

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
女性	0.022	0.264	0.007	1.022	0.605 ~ 1.706	0.935
年龄（岁）	0.057	0.013	19.918	1.059	1.033 ~ 1.087	< 0.001
肌酐（μmol/L）	0.003	0.001	4.973	1.003	1.000 ~ 1.005	0.021
乳酸（mmol/L）	0.175	0.058	9.242	1.191	1.064 ~ 1.335	0.002
肌酸激酶同工酶（U/L）	0.003	< 0.001	15.721	1.003	1.001 ~ 1.004	< 0.001
AST（U/L）	< 0.001	< 0.001	0.143	1.000	0.999 ~ 1.001	0.706
行急诊PCI术	-0.519	0.289	3.236	0.595	0.334 ~ 1.038	0.072
超敏C反应蛋白（mg/L）	0.001	0.003	0.254	1.001	0.996 ~ 1.007	0.589
B型脑钠肽前体（ng/L）	0.006	0.001	21.418	1.006	1.003 ~ 1.008	< 0.001
白细胞计数（× 10⁹/L）	0.048	0.025	3.606	1.049	0.998 ~ 1.102	0.058

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
女性	0.022	0.264	0.007	1.022	0.605 ~ 1.706	0.935
年龄（岁）	0.057	0.013	19.918	1.059	1.033 ~ 1.087	< 0.001
肌酐（μmol/L）	0.003	0.001	4.973	1.003	1.000 ~ 1.005	0.021
乳酸（mmol/L）	0.175	0.058	9.242	1.191	1.064 ~ 1.335	0.002
肌酸激酶同工酶（U/L）	0.003	< 0.001	15.721	1.003	1.001 ~ 1.004	< 0.001
AST（U/L）	< 0.001	< 0.001	0.143	1.000	0.999 ~ 1.001	0.706
行急诊PCI术	-0.519	0.289	3.236	0.595	0.334 ~ 1.038	0.072
超敏C反应蛋白（mg/L）	0.001	0.003	0.254	1.001	0.996 ~ 1.007	0.589
B型脑钠肽前体（ng/L）	0.006	0.001	21.418	1.006	1.003 ~ 1.008	< 0.001
白细胞计数（× 10⁹/L）	0.048	0.025	3.606	1.049	0.998 ~ 1.102	0.058

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
年龄（岁）	0.058	0.013	21.317	1.060	1.035 ~ 1.087	< 0.001
肌酐（μmol/L）	0.003	0.001	6.275	1.003	1.001 ~ 1.005	0.012
乳酸（mmol/L）	0.174	0.057	9.589	1.190	1.064 ~ 1.332	0.002
肌酸激酶同工酶（U/L）	0.003	0.001	21.381	1.003	1.001 ~ 1.004	< 0.001
行急诊PCI术	-0.537	0.287	3.486	0.585	0.328 ~ 1.018	0.062
B型脑钠肽前体（ng/L）	0.006	0.001	23.639	1.006	1.004 ~ 1.008	< 0.001
白细胞计数（× 10⁹/L）	0.054	0.024	5.094	1.055	1.006 ~ 1.105	0.024

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