血红蛋白和血清白蛋白评估老年慢性心力衰竭长期预后的价值

赵善隽; 陈君; 王大宇

doi:10.12125/j.chj.202106065

血红蛋白和血清白蛋白评估老年慢性心力衰竭长期预后的价值

Value of hemoglobin and serum albumin for assessing the long-term prognosis of chronic heart failure in the elderly

摘要

摘要:
目的探讨血红蛋白（Hb）和血清白蛋白（ALB）对老年慢性心力衰竭（CHF）患者长期预后的评估价值。
方法收集2018年2月至2019年4月我院收治的老年CHF患者200例，对患者的Hb和ALB水平进行检测。对出院后的患者进行3年的随访，依据随访患者预后分为存活组（n=142）和死亡组(n=58)，比较两组患者的临床数据。进行单因素和多因素分析明确患者死亡的独立危险因素，通过受试者工作特征曲线（ROC）确定Hb与ALB水平的截断点，依据患者预后的独立危险因素建立列线图预测模型并验证。
结果与存活组比较，死亡组既往心肌梗死比例显著升高（P<0.05）；超敏C反应蛋白（hs-CRP）、氨基末端脑钠尿肽前体（NT-proBNP）及心肌钙蛋白I（cTnI）显著升高（P<0.05），血清Hb、ALB水平及左室射血分数（LVEF）显著降低（P<0.01）。多因素Logistic回归分析发现：心肌梗死、血清hs-CRP升高、血清NT-proBNP升高、血清Hb降低、血清ALB降低及LVEF降低为患者死亡的独立危险因素。Hb预测患者死亡的ROC曲线下面积为0.753，截断点为117.8g/L，其灵敏度为72%，特异度75%；ALB预测患者死亡的ROC曲线下面积为0.878，截断点为34.70 g/L，其灵敏度为86%，特异度为79%。依据预后独立危险因素构建列线图模型，其一致性指数（C-index）为0.768（95%CI：0.716~0.820），ROC曲线下面积为0.840（95%CI：0.791~0.889），具有较好的区分度；Calibration曲线评价结果提示该模型具有较好的一致性。
结论低Hb及ALB水平是老年CHF患者预后的独立危险因素，对该类患者的预后具有较好的预测价值。

Abstract:
AIM To explore the value of hemoglobin (Hb) and serum albumin (ALB) in evaluating the long-term prognosis of elderly patients with chronic heart failure.
METHODS The clinical data of 200 elderly patients with chronic heart failure in our hospital from February 2018 to April 2019 were collected, and the levels of hemoglobin and serum albumin were detected. The patients after discharge were followed up for 3 years, and were divided into survival group (n=142) and death group (n=58) according to whether the follow-up patients died. Logistic multivariate regression was used to analyze the independent risk factors of patients' death, and the optimal cut-off points of Hb and ALB levels were determined by characteristic curve (ROC). A nomogram prediction model was established and verified according to the independent risk factors of patients' prognosis.
RESULTS Compared with the survival group, Compared with the survival group, the proportion of previous myocardial infarction in the death group was significantly higher (P<0.05); High sensitity C-reactive protein (hs-CRP), N-terminal pro brain natriuretic peptise (NT-proBNP) and cardiac troponin I (CTnI) increased significantly (P<0.05) and the levels of serum Hb, ALB and left ventricular ejection fraction (LVEF) decreased significantly (P<0.01). Multivariate Logistic regression analysis showed that myocardial infarction, elevated serum hs-CRP, elevated serum NT-proBNP, decreased serum Hb, decreased serum ALB and decreased LVEF were independent risk factors for death. The area under the ROC curve for Hb to predict the death of patients is 0.753, the cut-off point is 117.8g/L, its sensitivity is 72.00%, and its specificity is 75.20%. The area under ROC curve of ALB for predicting patient death is 0.878, the cutoff point is 34.70 g/L, and its sensitivity is 86.00% and specificity is 79.20%. According to the independent risk factors of prognosis, the nomogram model was constructed, and its consistency index (C-index) was 0.768 (95%CI: 0.716~0.820), and its ROC curve AUC was 0.840 (95%CI: 0.791~0.889), which had good discrimination. The evaluation results of Calibration curve indicate that the model has good consistency.
CONCLUSION Low Hb and ALB levels are independent risk factors for the prognosis of elderly patients with chronic heart failure, and have good predictive value for the prognosis of these patients.

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