Application value analysis of echocardiography in the risk assessment of cardiovascular adverse events in end-stage renal disease based on Lasso-Cox
李锦龙 1刘书涵 1徐玉 2郭诚 3叶方雄 3周青 1刘新艳
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作者信息
1. 1武汉大学人民医院超声医学科，武汉 430060
2. 2武汉大学人民医院心内科，武汉 430060
3. 3武汉大学人民医院肾内科，武汉 430060
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摘要
目的 探讨超声心动图（UCG）在终末期肾脏病（ESRD）心血管不良事件（CAE）风险评价中的应用价值。 方法 选取武汉大学人民医院2020年4月至2021年6月ESRD住院患者，以CAE为终点事件，随访至2022年7月，按结局发生与否分为事件组与非事件组。采用队列研究方式分析其临床资料、血液生化指标、超声心动图参数。以R语言（4.1.3版本）进行数据分析与绘图。利用Lasso回归筛选结合与非结合超声心动图的变量，并分别纳入多因素Cox回归建模。采用随机森林分析变量重要性，使用内部重抽样法并绘制校准曲线进行模型验证，使用C-index与净重新分类指数（NRI）评价与比较模型效能。对超声评估三尖瓣反流峰值流速（TRV）≥2.5 m/s的不同透析患者使用Kaplan-Meier方法绘制生存曲线并比较中位生存时间。 结果 年龄、CAE病史、血磷、血红蛋白、左房前后径（LAD）、二尖瓣E峰流速与二尖瓣环舒张早期运动速度比值（E/e’）、TRV与不良结局独立相关；随机森林显示，变量重要性依次为E/e’、LAD、CAE病史、血磷、血红蛋白、年龄、TRV。非结合与结合超声参数模型C-index分别为0.719（95%CI：0.690~0.748）与0.753（95%CI：0.726~0.780），校准曲线具有较好的一致性；1年事件发生NRI=0.168，2年事件发生NRI=0.277；Kaplan-Meier生存曲线显示，TRV≥2.5 m/s组中位生存时间（约279 d）低于TRV<2.5 m/s组（约619 d）。TRV≥2.5 m/s组腹膜透析中位生存时间（约316 d）大于血液透析（约244 d）。 结论 E/e’、LAD、TRV是患者CAE独立预测因素，E/e’、LAD是判别ESRD预后的重要UCG参数；TRV可为透析方式的选择提供有价值信息；UCG对ESRD心血管不良事件风险评价具有重要临床应用价值。 Objective To investigate the application value of echocardiography (UCG) in risk assessment of cardiovascular adverse events (CAE) in patients with end stage renal diseases (ESRD) . Methods Patients with ESRD hospitalized in Renmin Hospital of Wuhan University from April 2020 to June 2021 were selected. CAE was considered as the adverse outcome. They were followed up until July 2022 and divided into event group and non-event group according to the occurrence of outcome. The clinical data, blood biochemical parameters and echocardiographic parameters were analyzed by cohort study. Data analysis and drawing were performed in R language (version 4.1.3) . The variables of combined and uncombined echocardiography were screened by Lasso regression, and multivariate Cox regression modeling was included. Random forest was used to analyze the importance of variables, internal resampling method was used and calibration curves were drawn for model validation, and C-index and net reclassification index (NRI) were used to evaluate and compare model efficacy. Kaplan-Meier method was used to draw survival curves and compare the median survival times of different dialysis patients with peak tricuspid regurgitation velocity (TRV) ≥2.5 m/s as assessed by ultrasound. Results Age, CAE history, serum phosphorus, hemoglobin, left atrial anteroposterior diameter (LAD) , mitral E peak velocity and ratio of mitral to myocardial early velocities (E/e’) , TRV were independently associated with adverse outcomes. Random forest showed that the importance of variables in order of importance were: E/e’, LAD, CAE history, serum phosphorus, hemoglobin, age, TRV. The C-index of unbound and bound ultrasound parameter models were 0.719 (95%CI: 0.690-0.748) and 0.753 (95%CI: 0.726-0.780) , respectively. The calibration curves have good consistency. NRI=0.168 for 1-year events and 0.277 for 2-year events Kaplan-Meier survival curves showed that the median survival time of TRV≥2.5 m/s group (about 279 days) was lower than that of TRV< 2.5 m/s group (about 619 days) . In the TRV≥2.5 m/s group, the median survival time of peritoneal dialysis (about 316 days) was longer than that of hemodialysis (about 244 days) . Conclusion E/e’, LAD and TRV are independent predictor of CAE. E/e’ and LAD are important UCG parameters for prognosis of ESRD. TRV can provide valuable information for the selection of dialysis mode. UCG has important clinical application value for risk assessment of CAE in ESRD.
Abstract
Objective To investigate the application value of echocardiography (UCG) in risk assessment of cardiovascular adverse events (CAE) in patients with end stage renal diseases (ESRD) . Methods Patients with ESRD hospitalized in Renmin Hospital of Wuhan University from April 2020 to June 2021 were selected. CAE was considered as the adverse outcome. They were followed up until July 2022 and divided into event group and non-event group according to the occurrence of outcome. The clinical data, blood biochemical parameters and echocardiographic parameters were analyzed by cohort study. Data analysis and drawing were performed in R language (version 4.1.3) . The variables of combined and uncombined echocardiography were screened by Lasso regression, and multivariate Cox regression modeling was included. Random forest was used to analyze the importance of variables, internal resampling method was used and calibration curves were drawn for model validation, and C-index and net reclassification index (NRI) were used to evaluate and compare model efficacy. Kaplan-Meier method was used to draw survival curves and compare the median survival times of different dialysis patients with peak tricuspid regurgitation velocity (TRV) ≥2.5 m/s as assessed by ultrasound. Results Age, CAE history, serum phosphorus, hemoglobin, left atrial anteroposterior diameter (LAD) , mitral E peak velocity and ratio of mitral to myocardial early velocities (E/e’) , TRV were independently associated with adverse outcomes. Random forest showed that the importance of variables in order of importance were: E/e’, LAD, CAE history, serum phosphorus, hemoglobin, age, TRV. The C-index of unbound and bound ultrasound parameter models were 0.719 (95%CI: 0.690-0.748) and 0.753 (95%CI: 0.726-0.780) , respectively. The calibration curves have good consistency. NRI=0.168 for 1-year events and 0.277 for 2-year events Kaplan-Meier survival curves showed that the median survival time of TRV≥2.5 m/s group (about 279 days) was lower than that of TRV< 2.5 m/s group (about 619 days) . In the TRV≥2.5 m/s group, the median survival time of peritoneal dialysis (about 316 days) was longer than that of hemodialysis (about 244 days) . Conclusion E/e’, LAD and TRV are independent predictor of CAE. E/e’ and LAD are important UCG parameters for prognosis of ESRD. TRV can provide valuable information for the selection of dialysis mode. UCG has important clinical application value for risk assessment of CAE in ESRD.
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