Objective:To establish and verify a nomogram for predicting the risk of worsening chronic heart failure(WHF)in elderly patients,as well as to investigate the value of combining the nomogram with N-terminal B-type natriuretic peptide(NT-proBNP)in predicting WHF.Methods:We retrospectively reviewed and analyzed the clinical characteristics of 572 elderly patients with WHF(WHF group)and 561 elderly patients with stable chronic heart failure who underwent regular follow-up(Non-WHF group)in our medical center from January 2018 to June 2022.Clinical indexes between the two groups were compared.The elderly WHF nomogram was con-structed by LASSO regression combined with multivariate logistic regression analysis.The internal validation set was used to evaluate the feasibility of the nomogram.The receiver operating characteristic curve(ROC),calibra-tion curve,and decision curve analysis(DCA)were adopted to evaluate the discrimination,calibration,and clinical validity of the nomogram.The area under the receiver operating characteristic curve(AUC),integrated discrimi-nation index(IDI),and net reclassification index(NRI)were applied to evaluate the predictive value of the nomo-gram,NT-proBNP,and their combination in elderly patients with WHF.Results:Admission heart rate,concom-itant atrial fibrillation,left ventricular ejection fraction,red cell distribution width,creatinine,and blood urea ni-trogen/albumin ratio were independent predictors of WHF in elderly patients(P＜0.05).The visual nomogram was drawn based on the six variables,and the AUCs of the nomogram in the training set and validation set were 0.830(95％CI:0.802-0.858)and 0.834(95％CI:0.792-0.876).Calibration curves and DCA curves demon-strated perfect calibration and clinical practicability of the nomogram.This study found that the NT-proBNP levels of patients in the WHF group were significantly higher than those in the Non-WHF group(P＜0.001).Mean-while,the AUCs of the nomogram,NT-proBNP,and their combination were 0.830,0.890,and 0.924,respec-tively.Compared with NT-proBNP,the IDI and NRI of their combination were 0.073 and 0.065.Conclusion:The nomogram containing six predictors could be used to predict the risk of WHF in elderly patients.The com-bined assessment of nomogram and NT-proBNP contributes to recognizing the high risk of WHF in elderly pa-tients and helping medical staff to make clinical strategies.
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