脑出血术后患者非计划重返重症监护病房的风险评估

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【中图分类号】 R651 【文献标志码】 B 【文章编号】1672-7770（2025）04-0444-07

Risk assessment of unplanned intensive care unit readmission in postoperative patients with intracerebral hemorrhage MAO Jinlong， ZOU Mingming，RAO Wei， HUANGFU Luokai，CAO Weidong，LIANG Chunyang. 1OO853，China

Corresponding author: LIANG Chunyang

Abstract：ObjectiveTo identify therisk factorsassociated with unplanned readmissionto theNeurological Intensive Care Unit(（NICU） following surgery for intracerebral hemorrhage（ICH）patients.MethodsThis study utilized the MIMIC-Ildatabase toselect ICH patients whounderwent surgery，with anage ofover18 years oldand a minimumone-daystayintheICU.Thestudy extracted clinicaldata，including vital signs，laboratory indices, treatmentdetails，andsurvival data，focusingondatawithin24 hoursprior to ICUdischarge.Statisticalanalysis was performedwithunivariateand multivariateLogisticregresion to identifyindependentrisk factorsforunplanned readmission within7and3Odayspost-discharge.Furthermore，predictivemodelswere constructed，receiver operatingcharacteristic（ROC）curves were ploted，the area under thecurve（AUC）wascalculated，the optimal cutoff values were identified using the Youden Index，and the corresponding sensitivity，specificity，accuracy, positive predictivevalue，and negative predictive value(NPV）were calculated.ResultsA total of 58O patients wereincluded inthe study. Unplanned readmission within 7days(8.4%) and 30 days(13.3%）was significantly associated with lower pre-discharge Sp02 ，higher INR，higher Glasgow coma scale-Motor（GCS-M），concurrent pulmonary heart disease，metastatic cancer，and electrolyte imbalances.Notably，patients with higher GCS scores weremore likely tobereadmited，suggesting thatearlydischarge might be premature for these patients.Predictive models P7(AUC=0.73 ）and P30(AUC=0.64 ）were constructed based on independent risk factors.The optimal cutoff values were 9.7 for P7 (sensitivity0.469，specificity0.87，accuracy0.84，PPV0.26,andNPV0.95）and 5.5 for P30 （sensitivity O.78，specificity 0.41，accuracy 0.46，PPV 0.17，and NPV 0.92）. Conclusions Postoperative ICHpatients are atrisk of unplanned readmision，particularly those withcompromised cardiopulmonary function，coagulopathy，and electrolyte imbalances.Patients with a P7 score less than 9.7 may have a safer transfer outof the intensive care unit.Patients with a P30 scoreless than5.5are likelytohavea lower probability of long-term readmission to the intensive care unit. Monitoring SpO 2 post-discharge is crucial,and attention must be paid to the continuity of care after NICU discharge to reduce readmision rates.The studyunderscores the importanceof comprehensive patient management and follow-up to prevent adverse outcomes.

Keywords:intracerebral hemorrhage(ICH）；unplanned readmission；predictive model；MIMIC-Il database

自发性脑出血（intracerebralhemorrhage，ICH）是非创伤性脑内血管破裂，导致血液在脑实质内聚集，从而引发一系列症候群[]。（剩余17023字）