高敏感格拉斯哥评分与射血分数保留型心力衰竭患者长期预后的关联性分析

Association between high-sensitivity Glasgow prognostic score and long-term death for acute heart failure with preserved ejection fraction

目的:探索高敏感格拉斯哥评分(high-sensitivity modified Glasgow prognostic score, hs-mGPS)与急性射血分数保留型心力衰竭(heart failure with preserved ejection fraction, HFpEF)住院患者长期预后的关联性。方法:从重大慢病国家注册登记研究心力衰竭前瞻队列中选取HFpEF住院患者,纳入有基线白蛋白和高敏C反应蛋白(high-sensitivity C-reactive protein, hs-CRP)检测结果的患者,计算其hs-mGPS评分。依据hs-mGPS评分,将所纳入患者分为3组:0分组(hs-CRP≤3 mg/L)、1分组(hs-CRP>3 mg/L且白蛋白≥35 g/L)、2分组(hs-CRP>3 mg/L且白蛋白<35 g/L),探索HFpEF患者的hs-mGPS评分与长期全因死亡及心血管死亡的关联性。结果:共纳入1 575例急性HFpEF患者,中位年龄71(63,79)岁,女性占比50.7%;0分组656例(41.6%),1分组680例(43.2%),2分组239例(15.2%)。出院后患者的中位随访时间为4.54(4.09,4.39)年,642例(40.8%)患者发生全因死亡,其中400例(25.4%)发生心血管死亡。多因素Cox分析显示,1分组与2分组患者发生全因死亡风险分别是0分组患者的1.28倍(HR=1.28,95%CI:1.07~1.53,P<0.01)和2.21倍(HR=2.21,95%CI:1.77~2.76,P<0.01);此外,2分组患者发生心血管死亡风险是0分组患者的2.32倍(HR=2.32,95%CI:1.75~3.07,P<0.01)。结论:hs-mGPS与急性HFpEF住院患者的长期预后密切相关,其评分越高,出院后全因死亡与心血管死亡风险也越高。

Objective To analyze the relationship between high-sensitivity modified Glasgow prognostic score(hs-mGPS)and long-term death after discharge for heart failure with preserved ejection fraction(HFpEF).Methods Data were obtained from the patients hospitalized for acute HFpEF in the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Prospective Heart Failure Study.Patients with high-sensitivity C-reactive protein(hs-CRP)and albumin data were enrolled in this analysis.Patients were divided into hs-mGPS=0 group(hs-CRP≤3 mg/L),hs-mGPS=1 group(hs-CRP>3 mg/L and albumin≥35 g/L),hs-mGPS=2 group(hs-CRP>3 mg/L and albumin<35 g/L).We analyzed the association between hs-mGPS and risks of long-term all-cause death and cardiovascular death in patients with HFpEF.Results The study included 1575 acute HFpEF patients;the median age was 71(63,79)years,and 50.7%were women.There were 656(41.6%)patients in the hs-mGPS=0 group,680(43.2%)in the hs-mGPS=1 group,and 239(15.2%)in the hs-mGPS=2 group.The median follow-up time was 4.54(4.09,4.39)years.A total of 642(40.8%)patients died,among whom 400(24.4%)died for cardiovascular reasons.In multivariable Cox analyses,the risk of all-cause death in the hs-mGPS=1 and hs-mGPS=2 group were 1.28 times(HR=1.28,95%CI:1.07-1.53,P<0.01)and 2.21 times(HR=2.21,95%CI:1.77-2.76,P<0.01)than that in the hs-mGPS=0 group.Besides,the risk of cardiovascular death in the hs-mGPS=2 group was 2.32 times(HR=2.32,95%CI:1.75-3.07,P<0.01)than that in the hs-mGPS=2 group.Conclusion hs-mGPS is associated with prognosis in patients with acute HFpEF,and increasing hs-mGPS indicates higher risks of all-cause death and cardiovascular death.