沙库巴曲缬沙坦治疗老年心力衰竭患者的预后列线图建立及验证  

Development and validation of a prognostic nomogram for elderly heart failure patients receiving sakubatril/valsartan treatment

作　　者：白盼盼 李春霞 卜星彭 郭梅凤 任建辉 罗天娥[1] 陈还珍 Bai Panpan;Li Chunxia;Bu Xingpeng;Guo Meifeng;Ren Jianhui;Luo Tian′e;Chen Huanzhen(School of Public Health,Shanxi Medical University,Taiyuan 030012,China;Department of General Medicine,Shanxi Bethune Hospital,Taiyuan 030032,China;Department of Cardiology,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院,太原030012 [2]山西白求恩医院综合医疗科,太原030032 [3]山西医科大学第一医院心血管内科,太原030001

出　　处：《中华老年多器官疾病杂志》2023年第11期830-835,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：2021年山西省应用基础研究计划(自由探索类)第二批项目(20210302123409)。

摘　　要：目的对沙库巴曲缬沙坦治疗的心力衰竭(HF)患者建立列线图并验证,准确预测其1年内HF再入院的风险。方法回顾性分析2018年6月至2021年12月山西医科大学第一医院HF患者的病历资料,对最小绝对收缩和选择算子回归筛选的变量进行多因素Cox回归分析,并建立列线图。使用一致性指数、受试者工作特征(ROC)曲线和校准曲线评估列线图的预测准确性。采用SPSS 26.0、R 4.1.3软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ^(2)检验。结果多因素Cox回归分析示白细胞(HR=1.125,95%CI 1.016~1.245;P=0.023)、血清总胆固醇(HR=1.522,95%CI 1.080~2.144;P=0.016)、甘油三酯(HR=1.619,95%CI 1.109~2.363;P=0.013)和高密度脂蛋白胆固醇(HR=0.273,95%CI 0.125~0.598;P=0.001)是HF患者的预后预测因子,以此建立列线图模型。训练集C-index为0.749(0.678~0.820),6个月曲线下面积(AUC)=0.821(0.700~0.893),12个月AUC=0.771(0.575~0.836);测试集C-index为0.851(0.641~0.809),6个月AUC=0.851(0.692~0.940),12个月AUC=0.847(0.679~0.995),提示模型具有中等预测价值,校准图呈现出较好的一致性。结论基于临床电子病历,本研究得出白细胞、血清总胆固醇、甘油三酯和高密度脂蛋白胆固醇是沙库巴曲缬沙坦治疗HF患者的预后影响因素,构建的列线图具有良好的预测价值和临床实用性,利于评估患者短期预后。Objective To draw and validate a predictive nomogram for 1-year readmission for patients with heart failure(HF)receiving sakubatril/valsartan treatment.Methods A retrospective study was conducted on the medical records of HF patients at the First Hospital of Shanxi Medical University from June 2018 to December 2021.Cox multifactor analysis was performed on variables screened by least absolute shrinkage and selection operator regression analysis,and then a nomogram was plotted based on obtained results.The prediction ability was evaluated using the concordance index(C-index),receiver operating characteristic(ROC)curve and calibration curve.SPSS statistics 26.0 and R 4.1.3 software were used for statistical analysis.Data comparison between two groups was performed using student′s t test,Mann-Whitney U test or Chi-sqaure test depending on data type.Results Multivariate Cox regression analysis showed that white blood cell count(HR=1.125,95%CI 1.016-1.245;P=0.023),levels of total cholesterol(HR=1.522,95%CI 1.080-2.144;P=0.016),triglyceride(HR=1.619,95%CI 1.109-2.363;P=0.013)and high-density lipoprotein cholesterol(HR=0.273,95%CI 0.125-0.598;P=0.001)were prognostic factors in HF patients,and then a nomogram model was build based on these indicators.The C-index value of the training set was 0.749(0.678-0.820),with area under the ROC curve(AUC)of 0.821(0.700-0.893)and 0.771(0.575-0.836)for 6 and 12 months respectively.And the C-index value of the testing set was 0.851(0.641-0.809),with AUC of 0.851(0.692-0.940)and 0.847(0.679-0.995)for 6 and 12 months respectively.These results suggested that the model had moderate predictive value,and the calibration curves indicated the model had good consistency.Conclusion Based on clinical electronic medical records,white blood cell count,total cholesterol,triglyceride and highdensity lipoprotein cholesterol levels are prognostic factors in HF patients after sakubatril/valsartan treatment(P<0.05).Our nomogram has good predictive value and clinical utility,and is helpful for the ass

关 键 词：沙库巴曲缬沙坦 心力衰竭 预后 列线图 

分 类 号：R541.6[医药卫生—心血管疾病]