摘要
目的 基于老年营养风险指数(GNRI)及炎症指标中性粒细胞-淋巴细胞比率(NLR)根据多因素Cox回归分析构建列线图模型,预测慢性心力衰竭(CHF)患者心血管复合终点事件发生风险.方法 回顾性分析2021年1月至2022年10月于安徽医科大学第一附属医院心血管内科住院的418例慢性心力衰竭患者的相关临床资料.根据患者是否发生心血管复合终点事件(全因死亡或心衰复发加重再入院)分为两组,分别为发生心血管复合终点事件组(n=233)和未发生心血管复合终点事件组(n=185),采用Cox回归分析筛选发生复合终点事件的危险因素,将筛选出的独立预测因子构建列线图,预测慢性心力衰竭患者复合终点事件的发生风险.结果 本研究中多因素Cox回归分析结果显示:年龄的HR=1.021(1.007～1.036)、NLR的HR=1.092(1.053～1.133)、左室射血分数(LVEF)的HR=0.965(0.947～0.984)、体质指数(BMI)的HR=1.059(1.019～1.101)、GNRI评分的HR=2.611(1.865～3.656)、心房颤动的HR=1.459(1.097～1.939)、糖尿病的HR=1.886(1.354～2.626)是慢性心力衰竭患者发生复合终点事件独立危险因素,P＜0.05;钠-葡萄糖协同转运体蛋白2抑制剂(SGLT-2i)的HR=0.476(0.337～0.627)是患者发生复合终点事件独立保护性因素(P＜0.001).利用上述构成预后的危险因素绘制列线图,结果显示其预测性能良好,该模型在预测慢性心力衰竭患者复合终点事件发生风险方面具有较好的一致性.结论 基于GNRI评分、NLR联合传统危险因素根据多因素Cox回归分析构建列线图模型在预测慢性心力衰竭患者预后方面性能良好.能够早期筛选出可能导致心力衰竭复发加重的诱因及危险因素,为其临床治疗提供参考依据,在一定程度上可改善慢性心力衰竭患者的预后.
Abstract
Objective To predict the risk of cardiovascular composite endpoint events in patients with chronic heart failure(CHF)through establishing nomogram model based on scores of geriatric nutritional risk index(GNRI),neutrophil/lymphocyte ratio(NLR)and multi-factor Cox regression analysis.Methods The clinical materials were retrospectively analyzed in CHF patients(n=418)chosen from Department of Cardiology in the First Affiliated Hospital of Anhui Medical Universityfrom Jan.2021 to Oct.2022.The patients were divided,according to occurrence of cardiovascular composite endpoint events(all-cause death or re-admission due to heart failure relapse or exacerbation),into endpoint event group(n=233)and non-endpoint event group(n=185).The risk factors for cardiovascular composite endpoint events were screened by using Cox regression analysis.A nomogram was established by using screened independent predictive factors for predicting risk of cardiovascular composite endpoint events occurrence in CHF patients.Results The results of multi-factor Cox regression analysis showed that age(HR=1.021,95％CI:1.007-1.036),NLR(HR=1.092,95％CI:1.053-1.133),LVEF(HR=0.965,95％CI:0.947-0.984),BMI(HR=1.059,95％CI:1.019-1.101),GNRI scores(HR=2.611,95％CI:1.865-3.656),AF(HR=1.459,95％CI:1.097-1.939),diabetes(HR=1.886,95％CI:1.354-2.626)were independent risk factors of composite endpoint events(P＜0.05),and SGLT-2i(HR=0.476,95％CI:0.337-0.627)was an independent protective factor(P＜0.001)of composite endpoint events.A nomogram was established by using above risk factors of prognosis and analysis results showed its predictive ability was good.The calibration curve of nomogram showed that the model had a higher consistency in predicting risk of cardiovascular composite endpoint events in CHF patients.Conclusion The nomogram model established based on GNRI scores and NLR combined with traditional risk factors according to multi-factor Cox regression analysis has a higher performance in predicting prognosis in CHF patients.The nomogram model is able to screen the causative factors and risk factors that may lead to recurrence and aggravation of heart failure at an early stage,which can provide a reference basis for clinical treatment and improve prognosis in CHF patients to a certain extent.
基金项目
安徽省学术和技术带头人及后备人选学术科研项目(2021D279)
维普
万方数据