查尔森共病指数对晕厥患者短期及长期预后的预测价值

Evaluation of the Charlson comorbidity index for short-and long-term prognosis in patients with syncope

目的探讨查尔森共病指数(CCI)对晕厥患者短期及长期临床预后的评估价值。方法入选2018年6月18日至2021年7月19日在天津医科大学第二医院心脏科就诊的晕厥患者,明确患者的晕厥类型,经临床评估和调查研究获取基线资料并计算CCI,根据得分结果将患者划分为:极低疾病负担组(CCI评分为0分)、低疾病负担组(CCI评分为1~2分)、中等疾病负担组(CCI评分为3~4分)和严重疾病负担组(CCI评分≥5分)。使用Logistic回归分析评估CCI对晕厥患者短期(30 d)及长期(1、2、3年)晕厥复发风险、再入院风险及全因死亡风险之间的相关关系。结果最终纳入313例患者,其中57例为反射性晕厥,134例为心源性晕厥,122例为其他原因晕厥。多因素Logistic回归分析显示,CCI每增加1分,随访30 d及1年时患者再入院风险分别增加约0.4倍(OR=1.417,95%CI:1.057~1.899)和0.3倍(OR=1.300,95%CI:1.051~1.608);随访1、2、3年时的全因死亡风险均显著增加约0.8倍(1年:OR=1.785,95%CI:1.270~2.509;2年:OR=1.771,95%CI:1.179~2.662;3年:OR=1.785,95%CI:1.176~2.709)。CCI增加对于短期及长期随访时晕厥复发风险评估不具有统计学意义(P>0.05)。结论CCI与晕厥患者短期和长期再入院风险和全因死亡风险正向相关,但与晕厥复发风险之间无显著相关性。使用CCI早期识别高风险患者并进行重点监控和早期干预,根据共病情况制定个体化的治疗和康复计划可能有助于降低晕厥再入院率和全因死亡率。

Objective To explore the assessment value of Charlson comorbidity index(CCI)on short-term and long-term clinical prognosis of patients experiencing syncope.Methods Patients with syncope who visited the cardiology department of the Second Hospital of Tianjin Medical University from June 18,2018 to July 19,2021 were enrolled.we identified the syncope type of the patient,and baseline data were obtained and CCI were calculated through clinical assessment and survey study.According to the CCI classification,the disease burden of patients was classified as:very low(CCI 0),low(CCI 1-2),moderate(CCI 3-4),and severe(CCI≥5).Logistic regression analysis was used to evaluate the association of CCI with short-term(30 days)and long-term(1,2,and 3 years)risk of syncope recurrence,readmission,and death in syncope patients.Results A total of 313 patients were included,with reflex syncope in 57,cardiac syncope in 134,and other causes in 122.Multivariate Logistic regression showed that for every 1-point increase in CCI,the risk of patient readmission at 30 days and 1 year of follow-up increased by approximately 0.4 times(OR=1.417,95%CI:1.057-1.899)and 0.3 times(OR=1.300,95%CI:1.051-1.608),respectively.Furthermore,the risk of mortality at 1,2,and 3 years post-discharge was significantly elevated by approximately 0.8 times(1 year:OR=1.785,95%CI:1.270-2.509;2 years:OR=1.771,95%CI:1.179-2.662;3 years:OR=1.785,95%CI:1.176-2.709).However,increased CCI did not significantly predict the risk of syncope recurrence at short-and long-term follow-up(P>0.05).Conclusion CCI is positively associated with short-and longterm risk of readmission and risk of death in patients with syncope,it does not significantly correlate with the risk of syncope recurrence.Early identification of high-risk patients using CCI with focused surveillance and early intervention,and individualized treatment and rehabilitation plans based on co-morbidities may help reduce syncope readmission rates and mortality.