摘要
背景:Chagas病是拉丁美洲的一个重要健康问题,心脏受累与高水平的发病率及死亡率相关。作者研发了一种预测Chagas心脏病患者死亡风险的模型。方法:回顾性评价一个巴西地区队列中的424例门诊患者。采用Cox比例风险分析研究潜在危险因素与死亡的关系,并建立风险评分模型。在另一社区医院的153例患者中对该模型进行验证。结果:在平均7.9年的随访期内,模型研发队列中有130例患者死亡。
BACKGROUND: Chagas'disease is an important health problem in Latin America, and cardiac involvement is associated with substantial morbidity and mortality. We developed a model to predict the risk of death in patients with Chagas'heart disease. METHODS: We retrospectively evaluated 424 outpatients from a regional Brazilian cohort. The association of potential risk factors with death was tested by Cox proportional-hazards analysis, and a risk score was created. The model was validated in 153 patients from a separate community hospital. RESULTS: During a mean follow-up of 7.9 years, 130 patients in the development cohort died. Six independent prognostic factors were identified, and each was assigned a number of points proportional to its regression coefficient: New York Heart Association class III or IV(5 points), evidence of cardiomegaly on radiography(5 points), left ventricular systolic dysfunction on echocardiography(3 points), nonsustained ventricular tachycardia on 24-hour Holter monitoring(3 points), low QRS voltage on electrocardiography(2 points), and male sex(2 points). We calculated risk scores for each patient and defined three risk groups: low risk(0 to 6 points), intermediate risk(7 to 11 points), and high risk(12 to 20 points). In the development cohort, the 10-year mortality rates for these three groups were 10 percent, 44 percent, and 84 percent, respectively. In the validation cohort, the corresponding mortality rates were 9 percent, 37 percent, and 85 percent. The C statistic for the point system was 0.84 in the development cohort and 0.81 in the validation cohort. CONCLUSIONS: A simple risk score was developed to predict death in Chagas'heart disease and was validated in an independent cohort.
