Acute heart failure is a leading cause of hospitalization and death,and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources alloc...Acute heart failure is a leading cause of hospitalization and death,and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources allocation,avoiding the overtreatment of low-risk subjects or the early,inappropriate discharge of high-risk patients. Many clinical scores have been derived and validated for in-hospital and post-discharge survival; predictive models include demographic,clinical,hemodynamic and laboratory variables. Data sets are derived from public registries,clinical trials,and retrospective data. Most models show a good capacity to discriminate patients who reach major clinical end-points,with C-indices generally higher than 0.70,but their applicability in realworld populations has been seldom evaluated. No study has evaluated if the use of risk score-based stratification might improve patient outcome. Some variables(age,blood pressure,sodium concentration,renal function) recur in most scores and should always be considered when evaluating the risk of an individual patient hospitalized for acute heart failure. Future studies will evaluate the emerging role of plasma biomarkers.展开更多
目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020...目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020年6月,青岛市胶州中心医院收治的老年HF患者。根据患者30d的存活情况,分为死亡组和存活组。采用单因素分析和多因素Logistic回归构建NIRS和死亡预测模型。采用ROC分析、校准曲线和决策曲线评估老年HF患者死亡预测列线图模型的预测能力、校准能力和临床净获益。结果:本研究共纳入797例老年HF患者,164例(20.6%)老年HF患者在30d内死亡。NIRS由预后营养指数(prognosis nutrition index,PNI)、HGB-白蛋白-淋巴细胞-血小板(hemoglobin,albumin,lymphocyte,platelet,HALP)评分、单核细胞-高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)和CRP-白蛋白比值(C-reaction protein to albumin ratio,CAR)组成。多因素Logstic回归结果表明,NIRS(OR=11.867,95%CI:7.681~18.333,P<0.001)、高血压(OR=1.935,95%CI:1.18~3.175,P<0.001)和慢性阻塞性肺疾病(OR=4.306,95%CI:2.611~7.1,P<0.001)是老年HF患者30d死亡的危险因素。此外,老年HF患者30d死亡列线图模型ACU为0.855;校准曲线显示该模型预测概率与实际概率基本吻合;决策曲线显示该模型净获益良好。结论:INRS是老年HF患者30d死亡的独立预测因素。此外,老年HF患者30d死亡列线图模型可个体化预测老年HF患者30d内的死亡风险,帮助临床医生早期识别死亡高风险个体。展开更多
文摘Acute heart failure is a leading cause of hospitalization and death,and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources allocation,avoiding the overtreatment of low-risk subjects or the early,inappropriate discharge of high-risk patients. Many clinical scores have been derived and validated for in-hospital and post-discharge survival; predictive models include demographic,clinical,hemodynamic and laboratory variables. Data sets are derived from public registries,clinical trials,and retrospective data. Most models show a good capacity to discriminate patients who reach major clinical end-points,with C-indices generally higher than 0.70,but their applicability in realworld populations has been seldom evaluated. No study has evaluated if the use of risk score-based stratification might improve patient outcome. Some variables(age,blood pressure,sodium concentration,renal function) recur in most scores and should always be considered when evaluating the risk of an individual patient hospitalized for acute heart failure. Future studies will evaluate the emerging role of plasma biomarkers.
文摘目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020年6月,青岛市胶州中心医院收治的老年HF患者。根据患者30d的存活情况,分为死亡组和存活组。采用单因素分析和多因素Logistic回归构建NIRS和死亡预测模型。采用ROC分析、校准曲线和决策曲线评估老年HF患者死亡预测列线图模型的预测能力、校准能力和临床净获益。结果:本研究共纳入797例老年HF患者,164例(20.6%)老年HF患者在30d内死亡。NIRS由预后营养指数(prognosis nutrition index,PNI)、HGB-白蛋白-淋巴细胞-血小板(hemoglobin,albumin,lymphocyte,platelet,HALP)评分、单核细胞-高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)和CRP-白蛋白比值(C-reaction protein to albumin ratio,CAR)组成。多因素Logstic回归结果表明,NIRS(OR=11.867,95%CI:7.681~18.333,P<0.001)、高血压(OR=1.935,95%CI:1.18~3.175,P<0.001)和慢性阻塞性肺疾病(OR=4.306,95%CI:2.611~7.1,P<0.001)是老年HF患者30d死亡的危险因素。此外,老年HF患者30d死亡列线图模型ACU为0.855;校准曲线显示该模型预测概率与实际概率基本吻合;决策曲线显示该模型净获益良好。结论:INRS是老年HF患者30d死亡的独立预测因素。此外,老年HF患者30d死亡列线图模型可个体化预测老年HF患者30d内的死亡风险,帮助临床医生早期识别死亡高风险个体。
