基于D-二聚体与白蛋白比值的列线图模型预测射血分数保留型心力衰竭患者的预后  

Prognostic prediction of heart failure with preserved ejection fraction using a nomogram model based on D-dimer to albumin ratio

作　　者：张瑞[1] 孙敏妮 刘鑫[1] 王正斌[1] 王蕾[1] 刘宏生 ZHANG Rui;SUN Minni;LIU Xin;WANG Zhengbin;WANG Lei;LIU Hongsheng(Department of Emergency Medicine,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院急诊医学部,450052

出　　处：《心肺血管病杂志》2025年第1期9-16,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省高等学校重点科研项目计划(22A320079)。

摘　　要：目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属医院就诊的537例HFpEF患者,于12、24及36个月进行随访。结局事件为全因死亡和任何原因再住院。通过多因素COX回归分析,筛选出与HFpEF预后相关变量,基于这些变量构建列线图模型,并通过时间依赖的受试者工作特征曲线、校准曲线对模型的预测效能进行评估。结果:共纳入537例患者,有119例患者出现结局事件。筛选后,D-二聚体与白蛋白比值(D-dimer to albumin ratio,DAR)、高胆固醇血症、LDL-C、BMI、BNP和年龄被纳入列线图模型。在受试者工作曲线中,该模型在24个月内的曲线下面积(AUC)为0.750(95%CI:0.695~0.806),其一致性指数为0.764(95%CI:0.711~0.812),模型在36个月内的AUC为0.723(95%CI:0.669~0.780),在12个月内的AUC为0.700(95%CI:0.626~0.774),表现出稳定的预测效能。校准曲线和临床影响曲线显示模型预测结果与实际结果高度一致。结论:本研究基于DAR构建的列线图模型能够有效预测HFpEF患者在3年内的全因死亡和任何原因再住院风险,具有良好的预测效能和稳健性,能够准确地评估HFpEF患者的预后。Objective:The aim of the study is to construct and validate a nomogram model to predict the outcomes of heart failure with preserved ejection fraction(HFpEF)patients.Currently,there is relatively less research on HFpEF,and there is a lack of reliable prognostic prediction models for HFpEF.Methods:This study is a single-center retrospective cohort study that included 537 HFpEF patients who were treated at the First Affiliated Hospital of Zhengzhou University from January 1,2019,to January 1,2021.Follow-ups were conducted at 12,24,and 36 months.The endpoints were all-cause mortality and any-cause rehospitalization.Multivariate COX regression analysis was used to identify variables associated with HFpEF prognosis,based on which a nomogram model was constructed.The predictive performance of the model was evaluated using time-dependent receiver operating characteristic curves and calibration curves.Results:A total of 537 patients were included,with 119 patients experiencing endpoint events.After screening,the following variables were included in the nomogram model:D-dimer to albumin ratio(DAR),hypercholesterolemia,HDL-C,BMI,BNP,and age.In the receiver operating characteristic curves analysis,the model showed an area under curve(AUC)of 0.750(95%CI:0.695-0.806)with a concordance index of 0.764(95%CI:0.711-0.812)for predicting events at 24 months.The AUC were 0.723(95%CI:0.669-0.780)at 36 months,and 0.700(95%CI:0.626-0.774)at 12 months,demonstrating stable predictive performance.Calibration curves and clinical impact curves indicated that the model's predictions were highly consistent with actual outcomes.Conclusions:The nomogram model based on DAR effectively predicts the risk of all-cause death and any-cause rehospitalization within 3 years for HFpEF patients.The model shows good predictive performance and robustness,providing a more accurate assessment of HFpEF patient prognosis.

关 键 词：射血分数保留型心力衰竭 D-二聚体与白蛋白比值 列线图模型 预后预测 

分 类 号：R54[医药卫生—心血管疾病]