摘要
目的 分析慢性心力衰竭患者并发下呼吸道感染的危险因素并构建列线图预测模型.方法 选取2020年6月至 2022年6月于青海省第五人民医院收治的慢性心力衰竭患者182例作为研究对象,并根据患者是否发生下呼吸道感染分为感染组(n=87)和未感染组(n=95).对两组患者一般临床资料进行统计学分析并构建列线图预测模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析获取各因素的最佳截断值,采用多因素Logistic回归分析对影响慢性心力衰竭患者并发下呼吸道感染的独立危险因素进行分析.结果 两组患者年龄、吸烟史、糖尿病史、侵入性操作、营养不良、心房颤动、心功能分级、糖化血红蛋白(glyco-sylated hemoglobin,HbA1C)、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)比较,差异具有统计学意义(P<0.05).年龄、HbA1c、NT-proBNP、hs-CRP的曲线下面积(area under the curve,AUC)分别是0.765、0.817、0.707、0.757;最佳截断值分别为64岁、8.53%、333.83 pg/mL、8.85 mg/L.年龄、侵入性操作、营养不良、心功能分级、HbA1c、hs-CRP是慢性心力衰竭患者并发下呼吸道感染的独立危险因素(OR=1.487、1.752、1.869、1.714、1.612和1.637,95%CI:1.215～1.872、1.549～1.962、1.653～2.168、1.534～1.931、1.409～1.827和1.417～1.893,P<0.05).列线图预测模型的C-index为0.752(0.593～0.947),校准曲线趋近于理想曲线;决策曲线结果显示,风险阈值>0.07时,临床净收益较高.结论 年龄、侵入性操作、营养不良、心功能分级、HbA1c、hs-CRP是慢性心力衰竭患者并发下呼吸道感染的独立危险因素,基于此构建的Nomogram预测模型为慢性心力衰竭患者的防治提供重要的策略指导.
Abstract
Objectives To analyze the risk factors of lower respiratory tract infection in patients with chronic heart fail-ure and to construct a Nomogram prediction model.Methods A total of 182 patients with chronic heart failure admitted to The Fifth People's Hospital of Qinghai Province from June 2020 to June 2022 were selected as the research objects.According to whether the patients had lower respiratory tract infection,they were divided into infection group(n=87)and non-infection group(n=95).The general clinical data and serological indicators of the two groups were compared,and the optimal cut-off values of each factor were obtained by receiver operating characteristic(ROC)curve analysis.Multivariate Logistic analysis was used to analyze the independent risk factors of lower respiratory tract infection in patients with chronic heart failure.Results There were significant differences in age,smoking history,diabetes history,invasive procedures,malnutrition,atrial fibrillation,cardiac function classification,glycosylated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-proBNP)and high sensitivity C-reactive protein(hs-CRP)between the two groups(P<0.05).The area under the curve(AUC)of age,HbA1c,NT-proBNP and hs-CRP were 0.765,0.817,0.707 and 0.757,respectively.The optimal cut-off values were 64 years old,8.53%,333.83 pg/mL and 8.85 mg/L,respectively.Age,invasive procedures,malnutrition,cardiac function grade,HbA1c,hs-CRP were independent risk factors for lower respiratory tract infection in patients with chronic heart failure(OR=1.487,1.752,1.869,1.714,1.612,and 1.637,95%CI:1.215-1.872,1.549-1.962,1.653-2.168,1.534-1.931,1.409-1.827 and 1.417-1.893,P<0.05).The C-index of the Nomogram prediction model was 0.752(0.593-0.947),and the calibration curve was close to the ideal curve.The results of decision curve showed that the clinical net benefit was higher when the risk threshold was>0.07.Conclusions Age,invasive procedures,malnutrition,cardiac function classification,HbA1c,and hs-CRP are inde-pendent risk factors for lower respiratory tract infection in patients with chronic heart failure.The Nomogram prediction model constructed based on this will provide important strategic guidance for the prevention and treatment of patients with chronic heart failure.
NETL
NSTL
维普
万方数据