作者：张艳艳，熊瑛霞，王真

单位：

100038 北京市，首都医科大学附属北京世纪坛医院急诊科

Units：

Department of Emergency，Capital Medical University Affiliated Beijing Shijitan Hospital，Beijing 100038，China

关键词：

心力衰竭；肾功能恶化；虚弱；Edomonton 虚弱量表；影响因素分析；预测

Keywords：

Heart failure；Worsening renal function；Frailty；Edmonton Frailty Scale；Root cause analysis；Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.028

Funds：

摘要：

背景　急性心力衰竭（AHF）患者肾功能恶化（WRF）发生风险较高，而虚弱是 AHF 患者预后不良的危险因素。故明确虚弱与 AHF 患者 WRF 的关系对防治 AHF 患者住院期间发生 WRF 具有一定参考价值。目的　分析入院时虚弱程度与 AHF 患者住院期间 WRF 的关系。方法　选取 2017 年首都医科大学附属北京世纪坛医院急诊科收治的 AHF 患者 83 例，根据住院期间是否发生 WRF 分为 WRF 组（n=22）和无 WRF 组（n=61）。比较两组患者一般资料、实验室检查指标、左心室射血分数（LVEF）及入院时 Edmonton 虚弱量表评分。AHF 患者住院期间 WRF 的影响因素分析采用多因素 Logistic 回归分析；绘制受试者工作特征（ROC）曲线以评价入院时Edmonton 虚弱量表评分对 AHF 患者住院期间 WRF 的预测价值。结果　WRF 组患者使用呼吸机者所占比例、血尿素氮、血清肌酐及入院时Edmonton 虚弱量表评分高于无 WRF 组（P ＜ 0.05）。多因素 Logistic 回归分析结果显示，入院时 Edomonton 虚弱量表评分是 AHF 患者住院期间 WRF 的独立影响因素〔OR=1.212，95%CI（1.004，1.464），P ＜ 0.05〕。ROC 曲线分析结果显示，入院时 Edomonton 虚弱量表评分预测 AHF 患者住院期间 WRF 的曲线下面积为 0.68〔95%CI（0.55，0.81）〕。结论　入院时虚弱程度可能是 AHF 患者住院期间 WRF 的影响因素，但其对 AHF 患者住院期间发生 WRF 的预测价值不高。

Abstract：

Background　The risk of worsening renal function（WRF）in patients with acute heart failure（AHF）is high，and frailty is a risk factor for poor prognosis in patients with AHF.Therefore，it is valuable to clarify the relationship between frailty and WRF in AHF patients during hospitalization.Objective　To analyze the association between degree of frailty at admission and WRF in patients with AHF during hospitalization.Methods　A total of 83 cases of AHF patients from the Emergency Department of Capital Medical University Affiliated Beijing Shijitan Hospital in 2017 were enrolled，and divided into WRF group（n=22）and non-WRF group（n=61）according to whether WRF occurred during hospitalization.The general information，laboratory examination data，left ventricular ejection fraction（LVEF）and Edmonton Frailty Scale score at admission were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of WRF in AHF patients during hospitalization；receiver operating characteristic（ROC） curve was made to evaluate the predictive value of Edmonton Frailty Scale score at admission for WRF in AHF patients during hospitalization.Results The proportion of ventilator users，blood urea nitrogen，serum creatinine and Edmonton Frailty Scale score at admission in WRF group were higher than those in non-WRF group（P ＜ 0.05）.Multivariate Logistic regression analysis showed thatEdmonton Frailty Scale score at admission was an independent influencing factor of WRF in AHF patients during hospitalization〔OR=1.212，95%CI（1.004，1.464），P ＜ 0.05〕.ROC curve analysis showed that Edmonton Frailty Scale score at admission could predict WRF in patients with AHF during hospitalization，and the area under the curve was 0.68〔95%CI（0.55，0.81）〕.Conclusion　The degree of frailty at admission may be the influencing factor of WRF in AHF patients during hospitalization，but its predictive value for the occurrence of WRF in AHF patients is poor.

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