慢性心力衰竭不良预后的风险模型构建

Risk Model Construction for Adverse Prognosis in Chronic Heart Failure

目的:分析慢性心力衰竭不良预后的相关因素并据此构建不良预后的风险模型。方法:回顾性分析本院2022年1月至2023年1月间收治的216例慢性心力衰竭(慢性心衰)患者资料,全部患者出院后随访3个月,根据美国纽约心脏病学会心衰分级标准(NYHA分级)评估全部患者的预后情况,据此划分为良好组171例与不良组45例。对比两组患者的一般资料、入院指标,将其中具有统计学差异的因素代入Logistic分析其与慢性心衰不良预后的关系。结果:预后不良组患者年龄、入院时间、入院NYHA分级均高于良好组,体重轻于良好组,入院收缩压低于良好组,K、Na、Cl均低于良好组(P<0.05);年龄偏大、住院时间较长、入院NYHA分级较高为慢性心衰不良预后的危险因素(OR≥1,P<0.05);入院收缩压较高、体重较重、Na较高、Cl较高、K较高为慢性心衰不良预后的保护因素(OR<1,P<0.05);Na≤127.95mmoL/L及联合风险模型对于慢性心衰不良预后具有较高预测价值(AUC>0.9,P<0.05);K≤3.42mmoL/L、Cl≤94.00mmoL/L对于慢性心衰不良预后具有中等预测价值(0.7<AUC≤0.9,P<0.05);收缩压≤133.50mmHg、入院体重≤66.45kg、年龄≥61.50岁、住院时间≥15.50d、入院NYHA分级≥3.5级对于慢性心衰不良预后具有较低预测价值(0.5≤AUC≤0.7,P<0.05)。结论:根据风险模型完善患者相关检查,及时给予专项治疗与防治,预防低钠血症、低钾血症与低氯血症的发生有利于提高慢性心力衰竭患者的预后。

Objective:To analyze the factors related to poor prognosis in chronic heart failure(CHF)and construct a risk model for poor prognosis.Methods:A retrospective analysis was conducted on 216 CHF patients.Patients were divided into good prognosis and poor prognosis groups based on the NYHA classification.Baseline characteristics and admission indicators were compared between the two groups.Logistic regression analysis was used to identify independent risk factors associated with adverse prognosis.Results:Patients in the poor prognosis group were older,had longer hospital stays,and higher NYHA classes.They also had lower weight,systolic blood pressure,and levels of potassium,sodium,and chloride.Multivariate logistic regression analysis showed that older age,longer hospital stay,and higher NYHA class were independent risk factors for adverse prognosis,while higher systolic blood pressure,weight,sodium,chloride,and potassium levels were protective factors.A risk model based on sodium levels had a high predictive value for adverse prognosis.Conclusion:The established risk model can be used to predict adverse outcomes in CHF patients.Early identification of high-risk patients and targeted interventions can improve the prognosis of CHF patients.