Risk factors of diuretic resistance in patients with acute heart failure and construction of a risk prediction model
Objective To analyze the risk factors of diuretic resistance in patients with acute heart failure(AHF)and to construct a risk prediction model,so as to provide reference for the clinical prevention and treatment of diuretic resistance.Methods The clinical data of 102 AHF patients admitted to the hospital from January 2019 to November 2021 were retrospectively analyzed.According to the occurrence of diuretic resistance during hospitalization,they were divided into resistance group and non-resistance group.The general data and laboratory indicators of patients were reviewed and recorded.The risk factors of diuretic resistance in AHF patients were analyzed by Logistic regression.A nomogram was drawn to construct the risk prediction model of diuretic resistance in AHF patients,and its performance in predicting for the risk of diuretic resistance in AHF patients was evaluated.Results During hospitalization,38/102(37.25％)patients developed diuretic resistance.Patients in the resistance group presented significantly higher New York Heart Association(NYHA)functional class on admission and higher proportions of hyponatremia and use of nonsteroidal anti-inflammatory drugs before admission than those of non-resistance group(P＜0.05).Significantly lower serum albumin level on admission,and higher serum levels of B-type natriuretic peptide(BNP),N-terminal B-type natriuretic peptide(NT-proBNP)and aldosterone were detected in the resistance group than those of non-resistance group(P＜0.05).Logistic regression analysis showed that the use of nonsteroidal anti-inflammatory drug before admission,and high levels of serum BNP,NT-proBNP,and aldosterone at admission were independent risk factors for diuretic resistance in AHF patients(OR＞1,P＜0.05).High serum albumin level on admission was the protective factor of diuretic resistance in AHF patients(OR＜1,P＜0.05).Based on the above influencing factors,a nomogram to predict diuretic resistance in AHF patients was constructed and validated.The results showed that the C-index value of the model was 0.967,and the model had good discrimination.The calibration curve Y was similar to the straight line X,and the accuracy of the nomogram was good.Conclusion The use of nonsteroidal anti-inflammatory drug before admission,high levels of serum BNP,NT-proBNP and aldosterone,and low levels of serum albumin on admission are all influencing factors for the occurrence of diuretic resistance in AHF patients.A nomogram based on the above factors has a good predictive value for the occurrence of diuretic resistance in AHF patients.
NETL
NSTL
万方数据
维普
