急性心力衰竭患者住院期间肾功能恶化预测模型的构建  

Establishment of a prediction model for the deterioration of renal function during hospitalization in the patients with acute heart failure

作　　者：程玲灵 姚佳萍 季茜茜 Cheng Lingling;Yao Jiaping;Ji Xixi(Department of Emergency Medicine,Zhejiang Provincial People′s Hospital&People′s Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院/杭州医学院附属人民医院急诊医学科,浙江杭州310014

出　　处：《中国急救医学》2025年第4期329-334,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的 分析影响急性心力衰竭患者住院期间肾功能恶化的相关因素,并据此建立预测模型。方法 对浙江省人民医院急诊科2021年1月至2023年12月收治的398例急性心力衰竭患者临床资料进行回顾性分析,根据住院期间肾功能恶化发生情况分为恶化组(n=79)和未恶化组(n=319)。比较两组一般资料、住院期间相关治疗措施及实验室指标,采用Lasso回归及Logistic回归分析筛选影响急性心力衰竭患者肾功能恶化的相关因素,并据此构建预测模型,通过决策曲线、列线图及校准曲线评价模型的预测效能。结果 恶化组患者合并高血压、未使用SGLT-2抑制剂、呋塞米日剂量≥80 mg占比及入院时氨基末端脑钠肽前体(NT-proBNP)、肌酐水平高于未恶化组,入院时血红蛋白水平低于未恶化组(均P<0.05)。Lasso回归及Logistic回归分析显示,上述因素均是急性心力衰竭患者肾功能恶化的危险因素(P<0.05)。基于回归分析结果构建预测模型,绘制模型的决策曲线发现,阈值在0.00~0.93,模型临床净收益率始终大于0,最大净收益率为0.183;绘制列线图将患者肾功能恶化风险可视化,结果显示,模型预测急性心力衰竭患者肾功能恶化的C-index为0.945(95%CI 0.914~0.973),且校准曲线趋近于理想曲线。结论 基于合并高血压、SGLT-2抑制剂使用情况、呋塞米日剂量及入院时血红蛋白、NT-proBNP、肌酐水平构建的预测模型对急性心力衰竭患者肾功能恶化风险具有理想的预测效能。Objective To analyze the related factors that may affect the deterioration of renal function in the patients with acute heart failure during hospitalization and to establish a prediction model based on this,so as to provide references for early clinical identification of renal function deterioration.Methods The clinical data of 398 patients with acute heart failure admitted to the emergency department of Zhejiang Provincial People′s Hospital from January 2021 to December 2023 were retrospectively analyzed.Based on the occurrence of renal function deterioration during hospitalization,the patients were divided into deterioration group(n=79)and non-deterioration group(n=319).The general data,relevant treatment measures and laboratory indicators during hospitalization were compared between the two groups.Lasso regression and Logistic regression analysis were used to screen the related factors that may affect the deterioration of renal function in the patients with acute heart failure.Based on these factors,a prediction model was constructed,and the prediction efficiency of the model was evaluated by decision curve,nomogram and calibration curve.Results Compared with the non-deterioration group,the patients in the deterioration group had the higher proportion of hypertension,no use of sodium-dependent glucose transporters 2(SGLT-2)inhibitors,daily doses of furosemide≥80 mg,the higher levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and creatinine on admission,and the lower hemoglobin levels upon admission(P<0.05).Lasso regression and Logistic regression analysis showed that the above-mentioned factors may all be risk factors for the deterioration of renal function in the patients with acute heart failure(P<0.05).Based on the results of regression analysis,the prediction model was constructed,and the decision curve of the model was drawn.It was found that when the threshold was in the range of 0.00-0.93,the clinical net benefit rate of the model was always greater than 0,and the maximum net benefit rate

关 键 词：肾功能 恶化 急性心力衰竭 预测模型 高血压 钠-葡萄协同转运蛋白2抑制剂 呋塞米日剂量 血红蛋白 

分 类 号：R54[医药卫生—心血管疾病]