高敏感格拉斯哥预后评分与射血分数降低型心力衰竭患者长期预后的相关性分析

Correlation Analysis between High-sensitivity Modified Glasgow Prognostic Score and Long-term Prognosis in Patients with Heart Failure with Reduced Ejection Fraction

目的 分析射血分数降低型心力衰竭(heart failure with reduced ejection fraction,HFrEF)住院患者入院时的高敏感格拉斯哥预后评分(high-sensitivity modified Glasgow prognostic score,Hs-mGPS)与出院后长期死亡风险的关系。方法 从重大慢病国家注册登记研究-心衰前瞻队列研究中选取HFrEF住院患者,纳入有基线高敏C反应蛋白(high-sensitivity C-reactive protein,HsCRP)与白蛋白数据的患者,计算其Hs-mGPS。HS-mGPS的计算方式为:HsCRP> 3 mg/L且白蛋白<35 g/L计2分;HsCRP> 3 mg/L且白蛋白≥35 g/L计1分;HsCRP≤3 mg/L计0分。患者按照Hs-mGPS得分进行分组。分析Hs-mGPS与HFrEF患者的全因死亡及心血管死亡风险间的关联。结果 本研究共纳入1694例HFrEF住院患者,655例(38.7%)Hs-mGPS为0分,768例(45.3%)Hs-mGPS为1分,271例(16.0%)Hs-mGPS为2分。患者出院后中位随访时间4.54(4.09,4.39)年。多因素Cox分析显示,相较于Hs-mGPS为0分的患者,Hs-mGPS为1分与Hs-mGPS为2分的患者发生全因死亡(HR=1.32,95%CI:1.13~1.55,P <0.01;HR=1.49,95%CI:1.21~1.84,P <0.01)和心血管死亡(HR=1.36,95%CI:1.13~1.64,P <0.01;HR=1.38,95%CI:1.08~1.78,P <0.01)的风险较高。结论 Hs-mGPS可应用于评估急性HFrEF住院患者的长期预后,其评分越高,出院后的全因与心血管死亡风险也越高。

Objective To analyze the association between high-sensitivity modified Glasgow prognostic score (Hs-mGPS) at admission and long-term risk of death after discharge among patients with heart failure with reduced ejection fraction (HFrEF).Methods Data were obtained from the patients hospitalized for acute heart failure (HF) with reduced ejection fraction in the China Patientcentered Evaluative Assessment of Cardiac Events (PEACE)-Prospective Heart Failure Study.Patients with high-sensitivity C-reactive protein (HsCRP) and albumin data at admission were enrolled in this analysis,and the patients’Hs-mGPS were calculated.Patients with both HsCRP>3 mg/L and albumin3 mg/L and albumin≥35 g/L were classified to a score of 1;and patients with HsCRP≤3 mg/L were classified to a score of 0.The enrolled patients were categorized according to their Hs-mGPS.The association between Hs-mGPS and risk of death in the patients with HFrEF were analyzed.Results The study included 1694 patients.There were 655 (38.7%) patients with Hs-mGPS=0,768 (45.3%) patients with Hs-mGPS=1,and 271(16.0%) patients with Hs-mGPS=2.The median follow-up time was 4.54 (4.09,4.39) years.In multivariable Cox analyses,compared with the patients with Hs-mGPS=0,those patients with Hs-mGPS=1 and Hs-mGPS=2 had higher risks of all-cause death (HR=1.32,95%CI:1.13-1.55,P<0.01;HR=1.49,95%CI:1.21-1.84,P<0.01)and cardiovascular death (HR=1.36,95%CI:1.13-1.64,P<0.01;HR=1.38,95%CI:1.08-1.78,P<0.01).Conclusions Hs-mGPS can be used in evaluating long-term prognosis among patients with HFrEF,and increasing Hs-mGPS indicates higher risks of all-cause and cardiovascular death.