摘要
目的:评估国家预警评分系统(national early warning score,NEWS)联合白蛋白预测急性心力衰竭患者不良预后的价值.方法:选取2015年1月至2020年12月入住宣武医院急诊重症监护室的急性心力衰竭患者共524例,按住院期间的预后情况分为预后不良组及无预后不良组,收集两组患者的一般临床及生化指标,采用单因素、多因素统计分析,筛选预后不良的独立危险因素,结合ROC曲线计算敏感性、特异性.结果:524例患者中有278例发生预后不良,与无预后不良组患者相比,单因素分析显示预后不良组患者年龄较小,白蛋白水平较低,NEWS更高,NYHA分级较高(均P＜0.05);多因素Logistic回归结果显示,NEWS越高,心力衰竭患者发生不良预后的风险越大,具有统计学意义(OR=1.34,95％CI:1.21～1.50,P＜0.001);白蛋白水平越低,心力衰竭患者发生不良预后的风险越大,差异有统计学意义(OR=0.94,95％CI:0.88～1.00,P=0.038),NYHA分级越高,心力衰竭患者发生不良预后的风险越大,具有统计学意义(OR=13.01,95％CI:8.39～20.19,P＜0.001).绘制ROC曲线,预测不良预后的曲线下面积NEWS为0.77,白蛋白为0.61,NEWS联合白蛋白为0.79,联合指标的曲线下面积优于单独NEWS评分(Z=2.112,P=0.035).结论:NEWS联合白蛋白在急性心力衰竭患者的不良预后中有一定的预测价值.
Abstract
Objective:To evaluate the value of the national early warning score(NEWS)combined with albumin in predicting the poor prognosis of patients with acute heart failure.Methods:A total of 524 patients with acute heart failure admitted to the emergency intensive care unit from January 2015 to December 2020 were enrolled,and they were divided into poor prognosis group and no poor prognosis group according to their prognosis during hospitalization.ROC to calculate sensitivity and specificity.Results:Compared with the patients without poor prognosis,univariate analysis showed that the patients in the poor prognosis group were younger,lower albumin level,higher in NEWS,and higher in NYHA score(all P＜0.05),and the results of multivariate logistic regression showed that the higher the NEWS,the greater the risk of poor prognosis in patients with heart failure,which was statistically significant(OR=1.34,95％CI:1.21-1.50,P＜0.001),the lower the albumin level,the greater the risk of poor prognosis in patients with heart failure(OR=0.94,95％CI:0.88-1.00,P=0.038),the higher the NYHA grade,the greater the risk of poor prognosis in patients with heart failure(OR=13.01,95％CI:8.39-20.19,P＜0.001).The area under the curve of ROC was plotted,and the area under the curve for predicting poor prognosis was 0.77,the albumin was 0.61,and the area under the curve of NEWS combined with albumin was 0.79,and the area under the curve of the combined index was better than the NEWS score alone(Z=2.112,P=0.035).Conclusions:NEWS combined with albumin can predict the adverse prognosis of patients with acute heart failure,and we can further explore whether NEWS can be used as a predictive index.
基金项目
北京市科委项目(Z191100006619121)
NETL
NSTL
万方数据