老年心力衰竭病人衰弱的影响因素及风险预测模型的构建

Influencing factors and development of risk prediction model for frailty in elderly patients with heart failure

目的:调查老年心力衰竭病人衰弱的影响因素,并构建风险预测模型。方法:选取2021年8月—2022年10月在兰州市某三级甲等医院心内科及老年病科住院的335例老年心力衰竭病人作为研究对象,将其分为建模组(223例)和验证组(112例)。应用Logistic回归分析老年心力衰竭病人发生衰弱的影响因素并建立风险预测模型。采用Hosmer-Lemeshow拟合优度检验和受试者工作特征曲线验证模型的拟合优度及预测效能。结果:多因素分析结果显示,年龄、跌倒史、Charlson合并症指数问卷(CCI)评分、日常生活能力量表(ADL)评分是老年心力衰竭病人发生衰弱的影响因素。基于以上因素构建老年心力衰竭病人发生衰弱的风险预测模型,Hosmer-Lemeshow拟合优度检验显示,χ^(2)=2.696,P=0.952;受试者工作特征曲线下面积为0.949[95%CI(0.912,0.987)];模型最大Youden指数为0.744,最佳临界值为0.4527,敏感度为0.824,特异度为0.920。结论:老年心力衰竭病人发生衰弱的风险预测模型预测效果较好。

Objective:To investigate the influencing factors of frailty in elderly patients with heart failure and develop a risk prediction model.Methods:A total of 335 elderly patients with heart failure admitted to the cardiology and geriatric departments of a tertiary grade A hospital in Lanzhou city from August 2021 to October 2022 were selected as the study subjects.The patients were divided into modeling group(223 cases)and validation group(112 cases).Logistic regression was applied to analyze the influencing factors of frailty in elderly patients with heart failure.Than,the risk prediction model was established.The Hosmer⁃Lemeshow goodness of fit test were used to verify the goodness of fit and the receiver operator characteristic curve were used to predict efficiency of the model.Results:Multivariate analysis showed that age,history of falls,Charlson Comorbidity Index(CCI)score,and Activity of Daily Living Scale(ADL)score were the influencing factors of the occurrence of frailty in elderly patients with heart failure.Based on the above factors,a risk prediction model of frailty in elderly patients with heart failure was constructed.Hosmer-Lemeshow goodness of fit test showed that,χ^(2)=2.696,P=0.952.The area under the receiver operator characteristic curve was 0.949(95%CI 0.912-0.987).The maximum Youden index of the model was 0.744,the optimal critical value was 0.4527,the sensitivity was 0.824,and the specificity was 0.920.Conclusions:The risk prediction model of frailty in elderly patients with heart failure has good prediction performance.