Construction of nomogram model for thromboembolism in elderly patients with non-valvular atrial fibrillation
Objective To analyze the risk factors of thromboembolism in elderly patients with non-valvular atrial fibrillation(NVAF),to construct a nomogram prediction model,and to explore its predictive value.Methods Totally 1 267 elderly patients with NVAF were diagnosed and treated in People's Hospital of Xinjiang Uygur Autonomous Region from January 2021 to December 2022,and were divided into thromboembolism group(n=473)and non-thromboembolism group(n=794).The clinical data,laboratory indicators and echocardiographic indexes were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of thromboembolism in elderly patients with NVAF.According to the influencing factors,a nomogram model was constructed to predict thromboembolism in elderly patients with NVAF.ROC curve,calibration curve and clinical decision curve were drawn to evaluate the efficiency of nomogram model on predicting thromboembolism.Results The age was older,and the CHA2DS2-VASc,HAS-BLED score,and proportions of hypertension,coronary heart disease,peripheral vascular disease,cardiac insufficiency,hyperhomocysteinemia and hyperlipidemia were higher in thromboembolism group[(76.45±8.28)years,5.62±1.38,2.22±0.92,75.05％,61.10％,84.14％,64.06％,32.56％,45.24％]than those in non-thromboembolism group[(73.38±8.58)years,3.57±1.43,1.22±1.16,61.21％,55.16％,70.03％,53.65％,11.96％,33.25％](t=-6.241,t=-25.017,t=-16.918,x2=25.454,x2=4.270,x2=31.765,x2=13.140,x2=79.610,x2=18.149;all P values＜0.05),the course of NVAF was longer in thromboembolism group[3.00(1.00,7.00)years]than that in non-thromboembolism group[2.00(1.00,5.00)years](U=-4.160,P＜0.001).The neutrophil count,international standardized ratio,D-dimer,C-reactive protein,neutrophil/lymphocyte ratio,brain natriuretic peptide,troponin T,troponin I,and proportions of left atrial diameter＞40 mm and left ventricular ejection fraction ≤50％were higher in thromboembolism group[4.59 × 109/L(3.28 × 109/L,6.38× 109/L),1.27±0.47,0.78(0.39,1.83)mg/L,4.63(1.71,17.38)mg/L,3.52(2.28,6.64),264.69(126.00,529.70)ng/L,0.02(0.01,0.03)μg/L,0.01(0.01,0.03)μg/L,64.06％,55.39％]than those in non-thromboembolism group[4.16× 109/L(3.33× 109/L,5.54× 109/L),1.21±0.36,0.52(0.29,1.06)mg/L,3.70(1.57,11.31)mg/L,2.88(2.02,4.57),202.25(91.73,462.43)ng/L,0.01(0.01,0.03)μg/L,0.01(0.00,0.02)μg/L,52.52％,39.29％](U=-2.650,t=-2.480,U=-6.580,U=-2.060,U=-4.650,U=-2.820,U=-1.990,U=-3.320,x2=16.090,x2=30.990;all P values＜0.05).The prothrombin time was longer in thromboembolism group[(15.55±5.16)s]than that in non-thromboembolism group[(14.68±3.62)s](t=-3.510,P＜0.001).The lymphocyte count and albumin level were lower in thromboembolism group[1.27× 109/L(0.86× 109/L,1.69× 109/L),(37.02±5.80)g/L]than those in non-thromboembolism group[1.40× 109/L(1.00× 109/L,1.80× 109/L),(37.68±5.38)g/L](U=-2.880,P=0.004;t=2.030,P=0.044).Age(OR=1.030,95％CI:1.010-1.050,P＜0.001),course of NVAF(OR=1.030,95％CI:1.010-1.050,P=0.002),prothrombin time(OR=1.030,95％CI:1.010-1.060,P=0.042),D-dimer(OR=1.120,95％CI:1.060-1.190,P＜0.001),neutrophil/lymphocyte ratio(OR=1.040,95％CI:1.010-1.070,P=0.003),left atrial diameter(OR=1.310,95％CI:1.010-1.700,P=0.046),left ventricular ejection fraction(OR=1.400,95％CI:1.070-1.840,P=0.015),peripheral vascular disease(OR=2.930,95％CI:1.830-4.710,P＜0.001),hyperhomocysteinemia(OR=3.090,95％CI:2.260-4.220,P＜0.001),hyperlipidemia(OR=1.340,95％CI:1.030-1.750,P＜0.001)and hypertension(OR=1.350,95％CI:1.020-1.790,P＜0.001)were the influencing factors of thromboembolism in elderly patients with NVAF.When the optimal cut-off value of nomogram model was 0.383,the AUC for predicting thromboembolism was 0.750(95％CI:0.714-0.786,P＜0.001),with a sensitivity of 74.5％and a specificity of 64.4％.The calibration curve of nomogram model fitted well with the ideal curve,and the decision curve showed that nomogram model had a high clinical benefit in predicting thromboembolism in elderly patients with NVAF.Conclusions The patients with NVAF are at a high risk of thromboembolism when they have an old age,long course of NVAF,long prothrombin time,high D-dimer level,high neutrophil/lymphocyte ratio,left atrial diameter of＞40 mm,left ventricular ejection fraction of ≤50％,and complications of hypertension,peripheral vascular disease,hyperhomocysteinemia and hyperlipidemia.The nomogram model based on the above factors has a high predictive value.
non-valvular atrial fibrillationthromboembolismelderlynomogram model
NETL
NSTL
万方数据
