老年慢性心力衰竭住院患者衰弱影响因素及风险预测模型构建研究

谭杰; 陈曼曼; 陈凌云; 黄宇理

doi:10.16766/j.cnki.issn.1674-4152.003551

老年慢性心力衰竭住院患者衰弱影响因素及风险预测模型构建研究

doi: 10.16766/j.cnki.issn.1674-4152.003551

1.
阜阳市第五人民医院心血管科，安徽阜阳 236000
2.
蚌埠医科大学第一附属医院心血管科，安徽蚌埠 233004

基金项目:

安徽省教育厅人文社科重点项目 SK2020A0351

详细信息

通讯作者:
黄宇理，E-mail：13956382692@163.com

中图分类号: R541.6R592
计量
- 文章访问数: 46
- HTML全文浏览量: 23
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-21
- 网络出版日期: 2024-07-22

Study on the influence factors of frailty and the construction of risk prediction model in elderly inpatients with chronic heart failure

1.
Department of Cardiovascular Medicine, the Fifth People' s Hospital of Fuyang, Fuyang, Anhui 236000, China

摘要

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。
- 慢性心力衰竭 /
- 衰弱 /
- 老年 /
- 影响因素 /
- 风险预测模型
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.
- Chronic heart failure /
- Frailty /
- Old age /
- Influencing factors /
- Risk prediction model

HTML全文

图 1 患者衰弱风险预测模型的操作特征曲线

Figure 1. Operation characteristic curve of patient frailty risk prediction model

下载: 全尺寸图片幻灯片

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(%)]			0.601^a	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	3.660^b	< 0.001
吸烟[例(%)]	42(31.34)	24(37.50)	0.739^a	0.390
饮酒[例(%)]	59(44.03)	23(35.94)	1.169^a	0.280
NYHA心功能分级[例(%)]			15.931^c	< 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(%)]			8.248^c	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(%)]			5.497^a	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)	0.186^a	0.666
高血压	103(76.87)	47(73.44)	0.277^a	0.599
冠心病	106(79.10)	53(82.81)	0.376^a	0.540
慢性阻塞性肺病	35(26.12)	19(29.69)	0.278^a	0.598
脑卒中	39(29.10)	23(35.94)	0.940^a	0.332
BMI(x ± s)	23.32±2.16	23.66±2.94	0.842^b	0.402
住院时间[M(P₂₅, P₇₅)，d]	8(7, 9)	9(7, 12)	2.134^d	0.033
睡眠状态[例(%)]			6.874^c	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	2.208^b	0.028
ALB(x ± s，g/L)	42.76±3.03	42.13±2.73	1.403^b	0.162
HDL-C[M(P₂₅, P₇₅)，mmol/L]	1.32(1.15, 1.49)	1.22(1.13, 1.53)	1.046^d	0.295
LDL-C(x ± s，mmol/L)	1.88±0.44	1.97±0.56	1.172^b	0.244
Scr(x ± s，μmol/L)	106.20±43.04	121.76±47.60	2.299^b	0.023
NT-proBNP(x ± s，pg/mL)	417.98±261.66	650.38±338.80	4.841^b	< 0.001
LVEF(x ± s，%)	65.18±12.76	53.06±11.36	6.471^b	< 0.001
左心房内径(x ± s，mm)	41.19±9.14	42.64±6.82	1.251^b	0.213
主动脉内径(x ± s，mm)	31.78±6.23	32.97±6.60	1.236^b	0.218
自我管理能力[例(%)]			29.542^c	< 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。

下载: 导出CSV

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

下载: 导出CSV

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

下载: 导出CSV

参考文献(25)

[1]	DING H, JAYASENA R, CHEN S H, et al. The effects of telemonitoring on patient compliance with self-management recommendations and outcomes of the innovative telemonitoring enhanced care program for chronic heart failure: randomized controlled trial[J]. J Med Internet Res, 2020, 22(7): e17559. DOI: 10.2196/17559.
[2]	PACKER M, ANKER S D, BUTLER J, et al. Influence of neprilysin inhibition on the efficacy and safety of empagliflozin in patients with chronic heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial[J]. Eur Heart J, 2021, 42(6): 671-680. doi: 10.1093/eurheartj/ehaa968
[3]	张锦香, 邓力, 冯津萍, 等. 营养状况与老年女性慢性心力衰竭生存质量相关性研究[J]. 中华老年心脑血管病杂志, 2020, 22(5): 466-469. doi: 10.3969/j.issn.1009-0126.2020.05.006 ZHANG J X, DENG L, FENG J P, et al. Relationship between nutritional status and quality of life in elderly female CHF patients[J]. Chin J Geriatr Heart Brain Vessel Dis, 2020, 22(5): 466-469. doi: 10.3969/j.issn.1009-0126.2020.05.006
[4]	张艳超, 翟玉民. 血清胱抑素C及糖类抗原125对老年慢性心力衰竭患者预后的评估[J]. 中华老年心脑血管病杂志, 2019, 21(2): 137-140. doi: 10.3969/j.issn.1009-0126.2019.02.007 ZHANG Y C, ZHAI Y M. Value of serum Cys-C and CA-125 levels in predicting the outcome of elderly chronic heart failure patients[J]. Chin J Geriatr Heart Brain Vessel Dis, 2019, 21(2): 137-140. doi: 10.3969/j.issn.1009-0126.2019.02.007
[5]	PANDEY A, SEGAR M W, SINGH S, et al. Frailty status modifies the efficacy of exercise training among patients with chronic heart failure and reduced ejection fraction: an analysis from the HF-ACTION trial[J]. Circulation, 2022, 146(2): 80-90. doi: 10.1161/CIRCULATIONAHA.122.059983
[6]	杨琦琦, 孙颖, 邢云利, 等. 老年射血分数保留心力衰竭患者合并衰弱情况及其影响因素研究[J]. 中国全科医学, 2021, 24(11): 1354-1358, 1364. doi: 10.12114/j.issn.1007-9572.2021.00.411 YANG Q Q, SUN Y, XING Y L, et al. Frailty prevalence and associated factors in elderly heart failure patients with preserved ejection fraction[J]. Chinese General Practice, 2021, 24(11): 1354-1358, 1364. doi: 10.12114/j.issn.1007-9572.2021.00.411
[7]	陈力量, 冯小利, 殷兰芳, 等. 老年慢性心力衰竭病人衰弱综合征临床特点及相关危险因素分析[J]. 蚌埠医学院学报, 2022, 47(3): 326-329. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202203013.htm CHEN L L, FENG X L, YIN L F, et al. Analysis of the clinical characteristics and risk factors of frailty syndrome in elderly patients with chronic heart failure[J]. J Bengbu Med Coll, 2022, 47(3): 326-329. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202203013.htm
[8]	王华, 梁延春. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004 WANG H, LIANG Y C. Chinese Guidelines for Diagnosis and Treatment of Heart Failure 2018[J]. Chinese Journal of Cardiovascular Disease, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004
[9]	张玉莲, 牛亚琦, 王丹, 等. 2019年ICFSR国际临床实践指南解读及对我国老年人衰弱识别及管理的启示[J]. 护理研究, 2020, 34(14): 2433-2436. doi: 10.12102/j.issn.1009-6493.2020.14.001 ZHANG Y L, NIU Y Q, WANG D, et al. Interpretation of 2019 ICFSR International Clinical Practice Guidelines and its enlightenments to identification and management of frailty in the elderly people in China[J]. Chinese Nursing Research, 2020, 34(14): 2433-2436. doi: 10.12102/j.issn.1009-6493.2020.14.001
[10]	李涤凡, 尹德荣, 黄文伶, 等. 老年慢性心力衰竭患者自我管理现况调查和影响因素的研究[J]. 中国护理管理, 2020, 20(3): 360-366. doi: 10.3969/j.issn.1672-1756.2020.03.010 LI D F, YIN D R, HUANG W L, et al. Investigation of self-management behaviors and its influencing factors in elderly patients with Chronic Heart Failure[J]. Chin Nurs Manag, 2020, 20(3): 360-366. doi: 10.3969/j.issn.1672-1756.2020.03.010
[11]	胡寅田, 胡希文. 老年住院患者衰弱综合征与认知功能障碍和抑郁的相关性分析[J]. 中华全科医学, 2022, 20(11): 1913-1915, 1986. doi: 10.16766/j.cnki.issn.1674-4152.002734 HU Y T, HU X W. Correlation analysis of frailty syndrome with cognitive dysfunction and depression among elderly inpatients[J]. Chinese Journal of General Practice, 2022, 20(11): 1913-1915, 1986. doi: 10.16766/j.cnki.issn.1674-4152.002734
[12]	马璐瑶, 林萍, 王琴, 等. 老年慢性心力衰竭患者肌少症的筛查及干预研究[J]. 中华全科医学, 2022, 20(3): 419-423. doi: 10.16766/j.cnki.issn.1674-4152.002367 MA L Y, LIN P, WANG Q, et al. Screening and intervention of sarcopoenia in elderly patients with chronic heart failure[J]. Chinese Journal of General Practice, 2022, 20(3): 419-423. doi: 10.16766/j.cnki.issn.1674-4152.002367
[13]	MATSUE Y, KAMIYA K, SAITO H, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study[J]. Eur J Heart Fail, 2020, 22(11): 2112-2119. doi: 10.1002/ejhf.1926
[14]	顾俊, 胡晓云, 李云玲, 等. 衰弱指数对老年心力衰竭患者预后的评估[J]. 中华老年心脑血管病杂志, 2021, 23(10): 1027-1029. doi: 10.3969/j.issn.1009-0126.2021.10.006 GU J, HU X Y, LI Y L, et al. Evaluation of frailty index for prognosis of elderly patients with heart failure[J]. Chin J Geriatr Heart Brain Vessel Dis, 2021, 23(10): 1027-1029. doi: 10.3969/j.issn.1009-0126.2021.10.006
[15]	汪晨晨, 谢晖, 蔡维维. 社区老年人衰弱及其影响因素分析[J]. 中华全科医学, 2021, 19(4): 625-627, 683. doi: 10.16766/j.cnki.issn.1674-4152.001878 WANG C C, XIE H, CAI W W. Analysis of the frailty of the elderly in community and its influencing factors[J]. Chinese Journal of General Practice, 2021, 19(4): 625-627, 683. doi: 10.16766/j.cnki.issn.1674-4152.001878
[16]	DENFELD Q E, WINTERS-STONE K, MUDD J O, et al. The prevalence of frailty in heart failure: a systematic review and meta-analysis[J]. Int J Cardiol, 2017, 236: 283-289. doi: 10.1016/j.ijcard.2017.01.153
[17]	LENA A, ANKER M S, SPRINGER J. Muscle wasting and sarcopenia in heart failure-the current state of science[J]. Int J Mol Sci, 2020, 21(18): 6549. doi: 10.3390/ijms21186549
[18]	高静媛, 俞卫娟, 张佳, 等. 老年心力衰竭住院患者发生衰弱的影响因素分析[J]. 中国循证心血管医学杂志, 2022, 14(5): 565-567, 574. doi: 10.3969/j.issn.1674-4055.2022.05.12 GAO J Y, YU W J, ZHANG J, et al. Influence factors of asthenia in elderly hospitalized patients with heart failure[J]. Chin J Evid Based Cardiovasc Med, 2022, 14(5): 565-567, 574. doi: 10.3969/j.issn.1674-4055.2022.05.12
[19]	王巧稚, 吴海洋, 张璐, 等. 心血管病患者的衰弱发生情况及影响因素[J]. 中国健康教育, 2021, 37(2): 165-169. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJK202102018.htm WANG Q Z, WU H Y, ZHANG L, et al. Incidence and influencing factors of frailty in cardiovascular patients[J]. Chinese Journal of Health Education, 2021, 37(2): 165-169. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJK202102018.htm
[20]	汤莉莹, 李培, 白玉芝, 等. 老年心衰患者衰弱共病现状及短期预后的影响因素[J]. 中国急救医学, 2023, 43(6): 451-455. doi: 10.3969/j.issn.1002-1949.2023.06.005 TANG L Y, LI P, BAI Y Z, et al. The status quo of weakness comorbidity and the influencing factors of short-term prognosis in elderly patients with heart failure[J]. Chin J Crit Care Med Jun, 2023, 43(6): 451-455. doi: 10.3969/j.issn.1002-1949.2023.06.005
[21]	孙丽星, 杨燕, 华皎, 等. 老年慢性心力衰竭患者呼吸道感染状况及其影响因素[J]. 中国老年学杂志, 2020, 40(15): 3144-3147. doi: 10.3969/j.issn.1005-9202.2020.15.003 SUN L X, YANG Y, HUA J, et al. Status and influencing factors of respiratory tract infection in elderly patients with chronic heart failure[J]. Chinese Journal of Gerontology, 2020, 40(15): 3144-3147. doi: 10.3969/j.issn.1005-9202.2020.15.003
[22]	段菲, 闵春燕, 孙小卫, 等. 老年慢性阻塞性肺疾病患者发生衰弱的影响因素及其风险预测列线图模型构建[J]. 实用心脑肺血管病杂志, 2022, 30(9): 64-69. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL202209014.htm DUAN F, MIN C Y, SUN X W, et al. Influential factors and establishment of risk prediction nomograph model of frailty in elderly patients with COPD[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2022, 30(9): 64-69. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL202209014.htm
[23]	WENNBERG A M V, ST LOUIS E K. Interconnectedness among frailty, sleep, and cognition: recent findings and clinical implications[J]. Int Psychogeriatr, 2019, 31(6): 763-766. doi: 10.1017/S1041610219000462
[24]	吕秋, 邱清勇, 杜兰雪, 等. 老年射血分数保留型心衰合并衰弱的临床特征及NT-proBNP超声心动图参数变化的临床意义[J]. 河北医学, 2023, 29(9): 1479-1483. doi: 10.3969/j.issn.1006-6233.2023.09.013 LYU Q, QIU Q Y, DU L X, et al. Clinical characteristics and clinical significance of changes in NT-proBNP and echocardiographic parameters in elderly with ejection fraction preserved heart failure combined with debility[J]. Hebei Med, 2023, 29(9): 1479-1483. doi: 10.3969/j.issn.1006-6233.2023.09.013
[25]	裴莹莹, 王秀红, 汪俊华, 等. 社区老年慢性疼痛患者衰弱发生现状及其与社会支持和自我管理行为的关系[J]. 贵州医科大学学报, 2023, 48(6): 710-716. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202306014.htm PEI Y Y, WANG X H, WANG J H, et al. Status of debilitation in elderly patients with chronic pain in community and its relationship with social support and self-management behavior[J]. Journal of Guizhou Medical University, 2023, 48(6): 710-716. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202306014.htm