跟着指南走--心力衰竭模型对住院心力衰竭患者院内死亡的预测价值  

Predictive Value of Get With the Guidelines-Heart Failure Score on In-hospital Mortality in Patients With Heart Failure

作　　者：李莹莹[1] 罗瑶[1] 柴坷[1] 都明辉 程雅琳 王华[1] 杨杰孚[1] LI Yingying;LUO Yao;CHAI Ke;DU Minghui;CHENG Yalin;WANG Hua;YANG Jiefu(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Beijing(100730),China)

机构地区：[1]北京医院心血管内科国家老年医学中心,北京市100730

出　　处：《中国循环杂志》2021年第9期874-879,共6页Chinese Circulation Journal

摘　　要：目的:评估住院心力衰竭患者发生院内死亡的危险因素,并评价跟着指南走—心力衰竭(get with the guidelines-heart failure,GWTG-HF)模型对院内死亡的预测价值。方法:回顾性分析2013年1月1日至2019年3月1日在北京医院心血管内科住院的心力衰竭患者。收集临床数据并计算GWTG-HF模型的评分。根据患者院内生存情况,分为生存组和死亡组,比较两组临床特征差异,采用单因素及多因素回归分析探讨院内死亡危险因素。另根据GWTG-HF评分对患者进行分组以评估死亡差异,评分在16~35分者为低危组,36~41分者为中危组,≥42分者为高危组。结果:纳入的1888例住院心力衰竭患者,院内死亡76例(4.0%)。多元Logistic回归分析结果显示,年龄、入院时收缩压、心率、血清尿素氮、N末端B型利钠肽原(NT-proBNP)、心肌梗死病史、入院24 h内利尿剂使用剂量是心力衰竭患者院内死亡的独立危险因素(P均<0.05)。高危组(n=639)死亡率明显高于中危组(n=635)与低危组(n=614)(10.6%vs.0.7%;10.6%vs.0.7%;P均<0.001)。GWTG-HF评分>42.5分和NT-proBNP>2272.1 ng/L均可预测院内死亡,前者ROC曲线下面积为0.832(95%CI:0.786~0.879,P<0.01),后者为0.808(95%CI:0.758~0.857,P<0.01),二者预测院内死亡的ROC曲线下面积的差异无统计学意义(P=0.44)。结论:年龄、入院时收缩压、心率、血清尿素氮、NT-proBNP、心肌梗死病史及入院24 h内利尿剂使用剂量是心力衰竭患者院内死亡的独立危险因素。GWTG-HF模型可以用于院内死亡预测。Objectives:To evaluate the risk factors of in-hospital death among hospitalized patients with heart failure(HF),and to evaluate the performance of get with the guidelines-heart failure(GWTG-HF)score for predicting in-hospital mortality in patients with heart failure in China.Methods:We retrospective analyzed clinical data of hospitalized patients with HF in our department from January 1,2013 to March 1,2019.The clinical data included demographic data,diagnosis,symptoms and signs,electrocardiogram,echocardiogram,laboratory indicators,treatment and nosocomial death.GWTG-HF score was calculated in all enrolled patients.Results:A total of 1888 hospitalized patients with HF were included in the analysis,the average age of this population was(73.8±11.7)years old,and 1034 were males(54.8%).In-hospital death occurred in 76 patients(4.0%).Multivariate logistic regression analysis showed that age,on-admission systolic blood pressure,heart rate,serum urea nitrogen,NTproBNP,history of myocardial infarction,and the dose of diuretics used within 24 hours of admission were independent risk factors for in-hospital mortality(all P<0.05).Patients hospitalized with HF were further divided into low-risk,intermediate risk,and high-risk groups according to the GWTG-HF score.There were 614 cases in the low-risk group with 4 in-hospital deaths(0.7%);635 cases in the intermediate-risk group with 4 deaths(0.7%),and 639 cases in the high-risk group with 68 deaths(10.6%),P<0.001.The GWTG-HF score could be used to predict in-hospital mortality,and AUC of ROC was 0.832(95%CI:0.786-0.879,P<0.01).NT-proBNP could also predict in-hospital mortality,and AUC of ROC was 0.808(95%CI:0.758-0.857,P<0.01).There was no significant difference between GWTG-HF score and NT-proBNP for predicting inhospital mortality(P=0.44).Conclusions:On-admission systolic blood pressure,heart rate,serum urea nitrogen,NT-proBNP level,history of myocardial infarction,and dosage of diuretics within 24 hours of admission are independent risk factors for in-hospital mortality

关 键 词：心力衰竭 院内死亡 GWTG-HF模型 N末端B型利钠肽原 

分 类 号：R541.4[医药卫生—心血管疾病]