基于最佳住院时间的心力衰竭患者1年内再入院的影响因素

Influencing factors of 1-year readmission for heart failure patients based on optimal length of stay

目的:评估心力衰竭(心衰)患者住院时间(LOS)与1年内再入院风险的关系,探索最佳LOS患者再入院的影响因素。方法:收集2018-01-01—2020-12-31于川北医学院附属医院心血管内科住院治疗的心衰患者的临床资料,根据住院时间进行分组(LOS1:≤5d、LOS2:6~10d、LOS3:11~15d、LOS4:≥16d),通过单因素logistic回归分析展示不同LOS组与再入院的关系,筛选出OR比值最低的LOS组,根据1年内因心衰再入院的随访结果,把OR值最低的LOS患者分为再入院组、非再入院组,比较两组患者之间的基线资料,将差异有统计学意义的变量纳入多因素logistic回归分析,绘制受试者工作特征曲线(ROC)。结果:通过单因素回归分析可知,LOS2组患者OR值最低,共649例患者,其中再入院组为216例,非再入院组为433例;通过多因素logistic回归分析可知吸烟史、血同型半胱氨酸(Hcy)、N型末端脑钠肽前体(NT-proBNP)以及肾小球滤过率(eGFR)是LOS2组心衰患者1年内再入院的独立影响因素(P<0.05)。ROC曲线分析显示吸烟史、Hcy、eGFR、NT-proBNP单独以及联合预测LOS2患者1年内再入院的ROC曲线下面积(AUC)分别为0.594、0.627、0.643、0.733、0.775。结论:LOS2再入院风险最低。吸烟史、Hcy、NT-proBNP以及eGFR在LOS2组患者1年内再入院的风险中表现出良好的预测价值。

Objective:To evaluate the relationship between the length of stay(LOS)and the risk of readmission within 1year in patients with heart failure,and explore the optimal LOS patients and the influencing factors of readmission.Methods:Clinical data of patients with heart failure admitted to the Department of Cardiology,Affiliated Hospital of North Sichuan Medical College,between January 1,2018and December 31,2020were collected.The patients were categorized into four groups based on their length of stay(LOS1:≤5days,LOS2:6-10 days,LOS3:11-15days,LOS4:≥16days).Univariate logistic regression analysis was conducted to assess the relationship between the different LOS groups and readmission risk,and the hospitalization period with the lowest odds ratio(OR)was identified.Patients in the LOS group with the lowest OR were further divided into the readmission and non-readmission groups based on their follow-up readmission status within 1year.Baseline data between the two groups were compared,and variables with statistically significant differences were included in multivariate logistic regression analysis and receiver operating characteristic curve(ROC).Results:The LOS2had the lowest OR value.A total of 649patients was in LOS2group,including 216in the readmission group and 433in the non-readmission group.Multivariate logistic regression analysis revealed that smoking history,blood homocysteine(Hcy),N-terminal pro-brain natriuretic peptide(NT-proBNP),and glomerular filtration rate(eGFR)were independent influencing factors for 1-year hospital readmission in patients with heart failure in the LOS2group(P<0.05).ROC curve analysis shows that the area under the ROC curve(AUC)for predicting readmission within 1 year for LOS2patients based on smoking history,Hcy,NT-proBNP,eGFR as individual predictors and in combination were 0.594,0.627,0.643,0.733,and 0.775,respectively.Conclusion:LOS2had the lowest risk of readmission.The smoking history,Hcy,NT-proBNP,and eGFR are risk factors in the readmission within 1year for patients in the LOS2group.