射血分数降低的急性心力衰竭患者院内肾功能恶化的风险预测模型  

Risk prediction model of in-hospital renal function deterioration in patients with acute heart failure with decreased ejection fraction

作　　者：毛成陆 赵文燕 徐淼 MAO Chenglu;ZHAO Wenyan;XU Miao(Emergency Medicine Department,General Hospital of PLA Xinjiang Military Region,Urumqi 830000,China;Drug and Instrument Supervision and Inspection Station of the Support Department of PLA Xinjiang Military Region,Urumqi 830000,China;the First People’s Hospital of Urumqi,Urumqi 830000,China)

机构地区：[1]新疆军区总医院急诊医学科,乌鲁木齐830000 [2]新疆军区保障部药品仪器监督检验站,乌鲁木齐830000 [3]乌鲁木齐市第一人民医院,830000

出　　处：《武警医学》2024年第12期1077-1082,共6页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的 探讨射血分数降低的急性心力衰竭(AHFrEF)患者院内肾功能恶化(WRF)的影响因素,并构建其风险预测模型。方法 选取2020-01至2023-12新疆军区总医院收治的AHFrEF患者418例,根据住院7 d内是否发生院内WRF分为WRF组(320例)及无WRF组(98例),采用logistic回归分析AHFrEF患者发生院内WRF的影响因素,并构建其风险预测模型。结果 logistic回归分析结果显示,年龄、糖尿病、湿啰音≥1/3肺野、下肢水肿、颈静脉充盈>10 cm、肌酐、乳酸、N末端脑钠肽前体(NT-proBNP)、肌钙蛋白T、氯离子水平是影响AHFrEF患者院内WRF危险因素,血红蛋白为其保护因素(P<0.05);Bootstrap内部验证结果显示,一致性指数(C-index)为0.864;ROC曲线下面积为0.853,95%CI(0.812~0.947),灵敏度为87.25%,特异度为78.34%;Hosmer-Lemeshow拟合优度检验结果显示,χ^(2)=3.457,P=0.236。结论 年龄、糖尿病、容量负荷过重、肌酐、乳酸、NT-proBNP、肌钙蛋白T、氯离子水平是影响AHFrEF患者院内WRF的危险因素,而高血红蛋白为其保护因素;基于上述影响因素构建的列线图模型,能准确评估AHFrEF患者WRF发生风险。Objective To explore the factors influencing renal function deterioration(WRF)in patients with acute heart failure with decreased ejection fraction(AHFrEF),and to construct a risk prediction model.Methods A total of 418 patients with AHFrEF admitted to General Hospital of PLA Xinjiang Military Region from January 2020 to December 2023 were selected and divided into WRF group(98 cases)and non-WRF group(320 cases)according to whether hospital-acquired WRF occurred within 7 days of hospitalization.logistic regression was used to analyze the influencing factors of hospital-acquired WRF in AHFrEF patients,and a risk prediction model was established.Results Logistic regression analysis showed that age,diabetes,moist rales≥1/3 lung field,edema of lower limbs,jugular vein filling>10 cm,creatinine,lactic acid,N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin T and chloride ion levels were the risk factors of hospital-acquired WRF in AHFrEF patients,and hemoglobin was the protective factor(P<0.05).Bootstrap internal verification results show that the consistency index(C-index)was 0.864.The area under ROC curve was 0.853,95%CI(0.812-0.947),the sensitivity was 87.25%,and the specificity was 78.34%.Hosmer-Lemeshow goodness-of-fit test showed thatχ^(2)=3.457,P=0.236.Conclusions Age,diabetes,volume overload,creatinine,lactic acid,NT-proBNP,troponin T and chloride ion levels are the risk factors for in-hospital WRF in patients with AHFrEF,and high hemoglobin is the protective factor.The nomogram model based on the above factors can accurately evaluate the risk of WRF in patients with AHFrEF.

关 键 词：射血分数降低 急性心力衰竭 肾功能恶化 风险预测模型 

分 类 号：R541.6[医药卫生—心血管疾病]