Study on the influence factors of frailty and the construction of risk prediction model in elderly inpatients with chronic heart failure
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摘要:
目的 探讨老年慢性心力衰竭住院患者衰弱影响因素,构建衰弱风险预测模型,为预防和减少衰弱提供临床参考依据。 方法 采用便利抽样法选择2022年3月—2023年3月阜阳市第五人民医院心血管科住院的198例老年慢性心力衰竭患者作为研究对象,根据是否发生衰弱分成衰弱组及非衰弱组。采用二元logistic回归分析衰弱的影响因素,通过Hosmer-Lemeshow检验和ROC曲线分别检测模型拟合优度和预测效果。 结果 老年慢性心力衰竭住院患者衰弱发生率为32.32%(64/198),疲劳为最主要症状(51.01%, 101/198)。年龄(OR=1.101,P=0.007)、NYHA心功能分级(OR=2.550,P=0.011)、病程(OR=2.210,P=0.014)、睡眠状态(OR=2.215,P=0.010)、N末端脑钠肽前体(OR=1.003,P < 0.001)、左心室射血分数(OR=0.910,P < 0.001)及自我管理水平(OR=0.229,P < 0.001)均是衰弱发生的影响因素。回归模型有较好的拟合优度(χ2=2.915,P=0.940),AUC为0.913(P < 0.001,95% CI:0.870~0.956),灵敏度为89.1%,特异度为81.3%。 结论 老年慢性心力衰竭住院患者衰弱发生率较高,临床应重视高龄、心功能差、病程长、睡眠质量差及自我管理能力低的患者。该研究构建的老年慢性心力衰竭住院患者衰弱风险预测模型效果较好,可为患者衰弱风险评估及干预提供参考依据。 Abstract:Objective To explore the influencing factors of frailty in elderly patients with chronic heart failure, and build a frailty risk prediction model to provide clinical reference for preventing and reducing frailty. Methods A total of 198 elderly patients with chronic heart failure who were hospitalized in the cardiovascular Department of the Fifth People ' s Hospital of Fuyang from March 2022 to March 2023 were selected by convenience sampling method. They were divided into a frailty group and a non-frailty group according to whether frailty occurred. The influencing factors of frailty were analyzed by binary Logistic regression. Hosmer-Lemeshow test and ROC curve were used to detect the goodness of fit and prediction effect respectively. Results The incidence of frailty in elderly CHF patients was 32.32% (64/198), and fatigue was the main symptom (51.01%, 101/198). Age (OR=1.101, P=0.007), NYHA cardiac function grade (OR=2.550, P=0.011), course of disease (OR=2.210, P=0.014), sleep state (OR=2.215, P=0.010), N-terminal brain natriuretic peptide precursor (OR=1.003, P < 0.001), left ventricular ejection fraction (OR=0.910, P < 0.001) and self-management level (OR=0.229, P < 0.001) were influencing factors in the occurrence of frailty. The regression model had good goodness of fit (χ2=2.915, P=0.940), and the AUC under the ROC curve was 0.913 (P < 0.001, 95% CI: 0.870-0.956), sensitivity was 89.1%, specificity was 81.3%. Conclusion The incidence of frailty in elderly patients with chronic heart failure is high. Clinical attention should be paid to elderly patients with poor heart function, long course of disease, poor sleep quality, and low self-management ability. The frailty risk prediction model established in this study is effective in elderly patients with chronic heart failure, which can provide a reference for frailty risk assessment and intervention. -
Key words:
- Chronic heart failure /
- Frailty /
- Old age /
- Influencing factors /
- Risk prediction model
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表 1 老年CHF患者衰弱发生的单因素分析
Table 1. Univariate analysis of the incidence of frailty in elderly CHF patients
项目 非衰弱组(n=134) 衰弱组(n=64) 统计量 P值 性别[例(%)] 0.601a 0.438 男性 79(58.96) 34(53.12) 女性 55(41.04) 30(46.88) 年龄(x ± s,岁) 73.65±7.15 77.56±6.80 3.660b < 0.001 吸烟[例(%)] 42(31.34) 24(37.50) 0.739a 0.390 饮酒[例(%)] 59(44.03) 23(35.94) 1.169a 0.280 NYHA心功能分级[例(%)] 15.931c < 0.001 Ⅱ 74(55.22) 18(28.13) Ⅲ 54(40.30) 36(56.25) Ⅳ 6(4.48) 10(15.62) 病程[例(%)] 8.248c 0.016 < 5年 38(28.36) 18(28.13) 5~10年 64(47.76) 19(29.68) >10年 32(23.88) 27(42.19) 合并症[例(%)] 5.497a 0.019 1~2个 34(25.37) 7(10.94) ≥3个 100(74.63) 57(89.06) 既往基础病[例(%)] 2型糖尿病 44(32.84) 23(35.94) 0.186a 0.666 高血压 103(76.87) 47(73.44) 0.277a 0.599 冠心病 106(79.10) 53(82.81) 0.376a 0.540 慢性阻塞性肺病 35(26.12) 19(29.69) 0.278a 0.598 脑卒中 39(29.10) 23(35.94) 0.940a 0.332 BMI(x ± s) 23.32±2.16 23.66±2.94 0.842b 0.402 住院时间[M(P25, P75),d] 8(7, 9) 9(7, 12) 2.134d 0.033 睡眠状态[例(%)] 6.874c 0.032 良好 59(44.03) 22(34.38) 一般 53(39.55) 21(32.81) 较差 22(16.42) 21(32.81) Hb(x ± s,g/L) 125.96±18.06 119.90±18.08 2.208b 0.028 ALB(x ± s,g/L) 42.76±3.03 42.13±2.73 1.403b 0.162 HDL-C[M(P25, P75),mmol/L] 1.32(1.15, 1.49) 1.22(1.13, 1.53) 1.046d 0.295 LDL-C(x ± s,mmol/L) 1.88±0.44 1.97±0.56 1.172b 0.244 Scr(x ± s,μmol/L) 106.20±43.04 121.76±47.60 2.299b 0.023 NT-proBNP(x ± s,pg/mL) 417.98±261.66 650.38±338.80 4.841b < 0.001 LVEF(x ± s,%) 65.18±12.76 53.06±11.36 6.471b < 0.001 左心房内径(x ± s,mm) 41.19±9.14 42.64±6.82 1.251b 0.213 主动脉内径(x ± s,mm) 31.78±6.23 32.97±6.60 1.236b 0.218 自我管理能力[例(%)] 29.542c < 0.001 低水平 24(17.91) 35(54.68) 中水平 72(53.73) 23(35.94) 高水平 38(28.36) 6(9.38) 注:a为χ2值,b为t值,c为Z值,d为U值。 表 2 老年CHF患者衰弱发生影响因素的自变量赋值情况
Table 2. Independent variable assignment of factors affecting the incidence of fthenia in elderly CHF patients
变量 赋值方法 年龄 以实际值赋值 NYHA心功能分级 Ⅱ=1,Ⅲ=2,Ⅳ=3 病程 < 5年=1,5~10年=2,>10年=3 合并症 1~2个=1,≥3个=2 住院时间 以实际值赋值 睡眠状态 良好=1,一般=2,较差=3 Hb 以实际值赋值 Scr 以实际值赋值 NT-proBNP 以实际值赋值 LVEF 以实际值赋值 自我管理能力 低水平=1,中水平=2,高水平=3 表 3 老年CHF患者衰弱发生的影响因素分析
Table 3. Analysis of factors influencing the incidence of frailty in elderly CHF patients
变量 B SE Waldχ2 P值 OR值 95% CI 年龄 0.096 0.035 7.395 0.007 1.101 1.027~1.180 NYHA心功能分级 0.936 0.366 6.542 0.011 2.550 1.245~5.223 病程 0.793 0.323 6.024 0.014 2.210 1.173~4.162 合并症 0.896 0.684 1.720 0.190 2.451 0.642~9.357 住院时间 0.163 0.086 3.594 0.058 1.177 0.994~1.393 睡眠状态 0.795 0.310 6.598 0.010 2.215 1.207~4.063 Hb -0.015 0.013 1.367 0.242 0.985 0.961~1.010 Scr 0.004 0.005 0.526 0.468 1.004 0.993~1.015 NT-proBNP 0.003 0.001 13.729 < 0.001 1.003 1.001~1.004 LVEF -0.094 0.020 21.426 < 0.001 0.910 0.875~0.947 自我管理能力 -1.473 0.361 16.663 < 0.001 0.229 0.113~0.465 -
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