ABSTRACT
OBJECTIVE: This research aimed to establish a nomogram for predicting early death in viral myocarditis (VMC) patients. METHOD: A total of 362 consecutive VMC patients in Fujian Medical University Affiliated First Quanzhou Hospital between January 1, 2009, and December 31, 2019, were included. A least absolute shrinkage and selection operator (LASSO) regression model was used to detect the risk factors that most consistently and correctly predicted early death in VMC. The performance of the nomogram was assessed by calibration, discrimination, and clinical utility. RESULT: 9 factors were screened by LASSO regression analysis for predicting the early death of VMC. Combined with the actual clinical situation, the heart failure (HF) (OR: 2.13, 95% CI: 2.76-5.95), electrocardiogram (ECG) (OR: 6.11, 95% CI: 1.05-8.66), pneumonia (OR: 3.62, 95% CI: 1.43-9.85), brain natriuretic peptide (BNP) (OR: 4.66, 95% CI: 3.07-24.06), and lactate dehydrogenase (LDH) (OR: 1.90, 95% CI: 0.19-9.39) were finally used to construct the nomogram. The nomogram's C-index was 0.908 in the training cohort and 0.924 in the validation cohort. And the area under the receiver operating characteristic curve of the nomogram was 0.91 in the training cohort and 0.924 in the validating cohort. Decision curve analysis (DCA) also showed that the nomogram was clinically useful. CONCLUSION: This nomogram achieved an good prediction of the risk of early death in VMC patients.
ABSTRACT
OBJECTIVES: Cardiac postoperative cognitive dysfunction (c-POCD) is a common complication. This article established a nomogram by analyzing preoperative and intraoperative data to help identify high-risk patients and take effective management for prevention of c-POCD in early stage. MEASUREMENTS AND MAIN RESULTS: A total of 265 patients were enrolled in this study, 27 of whom were diagnosed as cardiac postoperative cognitive dysfunction (c-POCD). Patients were divided into a control group and c-POCD group. Univariate analysis suggested that gender, smoking, drinking history, hypertension, white blood cell (WBC) count, aspartate aminotransferase (AST), high-sensitivity troponin (hs-CRP), arrhythmia, left atrial diameter (LAD), cardiopulmonary bypass (CPB) time, and the ascending aortic block (AAB) time were correlated with postoperative cognitive dysfunction after cardiac surgery. Multivariate regression analysis indicated that CPB time (P = 0.0015, OR (95% CI) = 6.696 (2.068-21.675), hypertension (P = 0.0098, OR (95%CI) = 3.776 (1.377-10.356), WBC count (P = 0.0227, OR (95%CI ) = 3.358 (1.184-9.522), AST (P = 0.0128, OR (95%CI) = 3.966 (1.340-11.735), and arrhythmia (P = 0.0017, OR (95%CI) = 5.164 (1.855-14.371) were the independent risk factors of cognitive dysfunction after cardiac surgery and used to establish a nomogram for clinical use. The initial C-index of the nomogram was 0.8182 and good calibration. Corrected C-index value of 0.793 was reached after internal validation. The area under ROC curve of this model was 0.8188 (95%CI: 0.7185-0.9190). The positive odds ratio (PLR) was 1.21 (95%CI: 1.1-1.3), and the negative odds ratio (NLR) was 0.18 (95%CI: 0.03-1.3). CONCLUSION: This nomogram incorporating the CPB time, hypertension, WBC count, AST, and arrhythmia to predict the risk of c-POCD. The internal validation shows a good forecasting effect.