慢性心力衰竭患者发生衰弱的影响因素及其对住院期间不良事件的影响

Factors affecting frailty in patients with chronic heart failure and its impact on adverse events during hospitalization

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者发生衰弱的影响因素及其对住院期间不良事件的影响。方法选取2019年1月至2023年1月于四川省西昌市人民医院心内科收治的857例慢性心力衰竭患者,根据是否发生衰弱分为衰弱组(n=355)和非衰弱组(n=502)。收集慢性心力衰竭患者临床资料,采用单因素和多因素Logistic回归模型分析影响CHF患者衰弱的因素。比较两组住院期间不良事件发生率。结果857例慢性心力衰竭患者衰弱发生率为41.42%(355/857)。单因素分析显示,衰弱组年龄大于非衰弱组,纽约心脏协会(NYHA)心功能分级Ⅲ~Ⅳ级、高血压、糖尿病、冠心病、脑卒中史比例、N末端脑钠肽前体(NT-proBNP)高于非衰弱组,左室射血分数和血红蛋白低于非衰弱组(P<0.05)。多因素Logistic回归分析显示,年龄增加、NYHA心功能分级Ⅲ~Ⅳ级、高血压、糖尿病、冠心病、脑卒中史和NT-proBNP升高为影响慢性心力衰竭患者发生衰弱的独立危险因素,血红蛋白升高为独立保护因素(P<0.05)。857例CHF患者住院期间不良事件发生率为23.45%(201/857)。衰弱组住院期间不良事件发生率32.68%高于非衰弱组16.93%(P<0.05)。结论年龄、NYHA心功能分级、高血压、糖尿病、冠心病、脑卒中史、NT-proBNP和血红蛋白为CHF患者发生衰弱的独立影响因素,衰弱可增加CHF患者住院期间不良事件发生率。

Objective To investigate the factors influencing the occurrence of frailty in patients with chronic heart failure(CHF)and their impact on adverse events during hospitalization.Methods 857 CHF patients admitted to the Department of Cardiology of Xichang People's Hospital in Sichuan Province from January 2019 to January 2023 were selected and divided into 355 cases in the frailty group and 502 cases in the non-frailty group according to whether frailty occurred.Clinical data of CHF patients were collected and factors affecting frailty in CHF patients were analyzed using univariate and multivariate logistic regression models.The incidence of adverse events during hospitalization was compared between the frailty and non-frailty groups.Results The incidence of frailty in 857 patients with CHF was 41.42%(355/857).Univariate analysis showed that the age of the frailty group was greater than that of the non-frailty group,the New York Heart Association(NYHA)cardiac function classⅢ~Ⅳ,the proportion of hypertension,diabetes mellitus,coronary heart disease,and history of stroke,and,the N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)was higher than that of the non-frailty group,and the left ventricular ejection fraction and hemoglobin were lower than that of the non-frailty group(P<0.05).Multifactorial logistic regression analysis showed that increased age,NYHA cardiac function classⅢ~Ⅳ,hypertension,diabetes mellitus,coronary artery disease,history of stroke and elevated NT-proBNP were independent risk factors affecting the development of frailty in patients with CHF,and elevated hemoglobin were independent protective factors(P<0.05).The incidence of adverse events during hospitalization was 23.45%(201/857)in 857 CHF patients.The incidence of adverse events during hospitalization was 32.68%higher in the frailty group than in the non-frailty group at 16.93%(P<0.05).Conclusions Age,NYHA cardiac function class,hypertension,diabetes mellitus,coronary artery disease,stroke,NT-proBNP and hemoglobin are independent influences on the development of frailty in patients with CHF,and frailty can increase the incidence of adverse events during hospitalization in patients with CHF.