射血分数降低的急性心力衰竭患者院内肾功能恶化的风险预测模型
Risk prediction model of in-hospital renal function deterioration in patients with acute heart failure with decreased ejection fraction
毛成陆 1赵文燕 2徐淼3
作者信息
- 1. 830000 乌鲁木齐,新疆军区总医院急诊医学科
- 2. 830000 乌鲁木齐,新疆军区保障部药品仪器监督检验站
- 3. 830000,乌鲁木齐市第一人民医院
- 折叠
摘要
目的 探讨射血分数降低的急性心力衰竭(AHFrEF)患者院内肾功能恶化(WRF)的影响因素,并构建其风险预测模型.方法 选取2020-01 至2023-12 新疆军区总医院收治的AHFrEF患者418 例,根据住院7 d内是否发生院内WRF分为WRF组(320 例)及无WRF组(98 例),采用logistic回归分析AHFrEF患者发生院内WRF的影响因素,并构建其风险预测模型.结果 logistic回归分析结果显示,年龄、糖尿病、湿啰音≥1/3 肺野、下肢水肿、颈静脉充盈>10 cm、肌酐、乳酸、N末端脑钠肽前体(NT-proBNP)、肌钙蛋白T、氯离子水平是影响AHFrEF患者院内WRF危险因素,血红蛋白为其保护因素(P<0.05);Bootstrap内部验证结果显示,一致性指数(C-index)为 0.864;ROC曲线下面积为 0.853,95%CI(0.812～0.947),灵敏度为 87.25%,特异度为 78.34%;Hosmer-Lemeshow拟合优度检验结果显示,χ2=3.457,P=0.236.结论 年龄、糖尿病、容量负荷过重、肌酐、乳酸、NT-proBNP、肌钙蛋白T、氯离子水平是影响AHFrEF患者院内WRF的危险因素,而高血红蛋白为其保护因素;基于上述影响因素构建的列线图模型,能准确评估AHFrEF患者WRF发生风险.
Abstract
Objective To explore the factors influencing renal function deterioration(WRF)in patients with acute heart fail-ure with decreased ejection fraction(AHFrEF),and to construct a risk prediction model.Methods A total of 418 patients with AH-FrEF admitted to General Hospital of PLA Xinjiang Military Region from January 2020 to December 2023 were selected and divided into WRF group(98 cases)and non-WRF group(320 cases)according to whether hospital-acquired WRF occurred within 7 days of hospi-talization.logistic regression was used to analyze the influencing factors of hospital-acquired WRF in AHFrEF patients,and a risk pre-diction model was established.Results Logistic regression analysis showed that age,diabetes,moist rales≥1/3 lung field,edema of lower limbs,jugular vein filling>10 cm,creatinine,lactic acid,N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin T and chloride ion levels were the risk factors of hospital-acquired WRF in AHFrEF patients,and hemoglobin was the protective factor(P<0.05).Bootstrap internal verification results show that the consistency index(C-index)was 0.864.The area under ROC curve was 0.853,95%CI(0.812-0.947),the sensitivity was 87.25%,and the specificity was 78.34%.Hosmer-Lemeshow goodness-of-fit test showed that χ2=3.457,P=0.236.Conclusions Age,diabetes,volume overload,creatinine,lactic acid,NT-proBNP,troponin T and chloride ion levels are the risk factors for in-hospital WRF in patients with AHFrEF,and high hemoglobin is the protective fac-tor.The nomogram model based on the above factors can accurately evaluate the risk of WRF in patients with AHFrEF.
关键词
射血分数降低/急性心力衰竭/肾功能恶化/风险预测模型Key words
decreased ejection fraction/acute heart failure/deterioration of renal function/risk prediction model引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据