心力衰竭患者6949例在院30d病死率危险因素分析

Risk factors for 30-day mortality in hospitalized patients with congestive heart failure

目的:虽然心力衰竭(心衰)的治疗有了很大的进步,但心衰住院患者的在院病死率仍然很高。本项研究主要是调查影响心衰住院患者30 d在院病死率的独立危险因素。方法:选择1993年1月1日～2007年12月31日15年间心衰住院患者6 949(男4 344,女2 605)例,用Cox风险模型统计心衰住院患者在院病死率的独立危险因素。结果:对心衰住院患者在院病死率有显著影响的因素是:老龄[HR 1.030,95%CI(1.021-1.039)P=0.000];疾病包括冠心病、肺心病、心肌梗死、肺炎、脑血管病、消化道出血和肝硬化(P=0.000),心肌病(P=0.006)、瓣膜性心脏病(P=0.025)、慢性阻塞型肺病(P=0.032)。Kaplan-Meier生成曲线显示共患疾病数目越多,死亡概率越大(HR 1.04,95%CI 0.74-1.47到HR 2.88,95%CI 2.19-3.80,P<0.01);本研究时段(1998-2002vs.1993-1997,HR 0.71 95%CI 0.55-0.93,P<0.05);(2003-2007 vs.1993-1997,HR 0.59 95%CI 0.46-0.76,P<0.01)。结论:老龄、并发疾病、时段是影响心衰住院患者30 d在院病死率的独立危险因素。

AIM： To explore the risk factors for 30-day in-hospital mortality in congestive heart failure（CHF） patients.METHODS： A retrospective study was performed in 6 949 patients（4 344 males,2 605 females） from January 1,1993 through December 31,2007.A Cox proportional hazards model was developed to identify the independent risk factors.RESULTS： Cox analysis showed that the independent risk factors for in-hospital mortality in CHF patients were older age（HR 1.030,95% CI 1.021-1.039,P=0.000） and comorbid diseases including coronary heart diseases,cor pulmonale,myocardial infarction,pneumonia,cerebrovascular diseases,gastrointestinal bleeding and cirrhosis of liver（P=0.000）,cardiomyopathy（P=0.006）,valvular heart disease（P=0.025）,and chronic obstructive pulmonary disease（P=0.032）.Kaplan-Meier survival curves analysis showed a higher hospital mortality rate associated with increased number of comorbidities [hazard ratio（HR） from 1.04 95% CI 0.74-1.47 to HR 2.88 95% CI 2.19-3.80,P0.001] during the study period（1998-2002 vs.1993-1997,HR 0.71 95% CI 0.55-0.93,P=0.013）,（2003-2007 vs.1993-1997,HR 0.59 95% CI 0.46-0.76,P0.001）.CONCLUSION： Older age,comorbidities and time period are all independent risk factors for 30-day in-hospital mortality in CHF patients.