CHADS2评分联合白蛋白水平与老年血液透析患者预后的关系

The relationship between CHADS2 score combined with albumin level and prognosis of elderly hemodialysis patients

目的本研究旨在探索CHADS2评分联合白蛋白水平与老年血液透析患者预后的关系。方法回顾性分析2018年1月—2021年10月在南京市中西医结合医院进行血液透析的老年患者,按照生存情况分为生存组和死亡组,比较2组的临床基线资料、实验室指标、CHADS2评分,采用单因素和多因素Cox分析筛选老年血液透析患者的独立危险因素,并采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析评估CHADS2评分联合白蛋白水平与老年血液透析患者预后预测效能。结果生存组血红蛋白、血清白蛋白、高密度脂蛋白比死亡组水平高(P<0.05);生存组低密度脂蛋白比死亡组水平低(P<0.05);2组血清钙、血清磷水平差异无统计学意义。生存组CHADS2评分比死亡组低(P<0.05)。单因素Cox分析结果显示年龄、合并症(高血压、糖尿病)、低密度脂蛋白升高、CHADS2评分升高是患者预后的危险因素;血红蛋白升高、血清白蛋白升高、高密度脂蛋白升高是患者预后的保护因素。多因素Cox分析结果显示CHADS2评分升高是患者预后的独立危险因素;血清白蛋白升高是患者预后的独立保护因素。ROC曲线分析结果显示CHADS2评分与血清白蛋白水平联合对患者预后的预测效能更高。结论CHADS2评分是老年血液透析患者预后的独立危险性因素,白蛋白水平是老年血液透析患者预后的独立保护性因素,两者联合可为预测患者预后情况提供有效且可靠的参考。

Objective To explore the relationship between CHADS2 score combined with albumin level and prognosis of elderly hemodialysis patients.Methods Elderly patients undergoing hemodialysis in Integrated Traditional Chinese and Western Medicine Hospital of Nanjing City from January 2018 to October 2021 were retrospectively analyzed.They were divided into survival group and death group according to their survival conditions.The clinical baseline data,laboratory indexes and CHADS2 scores of the two groups were compared.Univariate and multivariate Cox analysis were used to screen the independent risk factors of elderly hemodialysis patients.The receiver operating characteristic curve(ROC)was used to evaluate the efficacy of CHADS2 score combined with albumin level in predicting the prognosis of elderly hemodialysis patients.Results The levels of hemoglobin,serum albumin and high-density lipoprotein of the survival group were higher than those of the death group(P<0.05).The level of low-density lipoprotein of the survival group was lower than that of the death group(P<0.05).There was no significant difference in the levels of serum calcium and serum phosphorus between the two groups.CHADS2 score of the survival group was lower than that of the death group(P<0.05).Univariate Cox analysis showed that age,comorbidities(hypertension,diabetes),elevated low-density lipoprotein,and elevated CHADS2 score were risk factors for prognosis of patients;elevated hemoglobin,serum albumin and high-density lipoprotein were protective factors for prognosis of patients.Multivariate Cox analysis showed that elevated CHADS2 score was an independent risk factor for prognosis of patients and elevated serum albumin was an independent protective factor for prognosis of patients.The results of ROC curve analysis showed that the combination of CHADS2 score and serum albumin level was more effective in predicting the prognosis of patients.Conclusion CHADS2 score is an independent risk factor for the prognosis of elderly hemodialysis patients,and albumin level is an independent protective factor for the prognosis of elderly hemodialysis patients.The combination of CHADS2 score and albumin level can provide an effective and reliable reference for prediction of the prognosis of patients.