论文部分内容阅读
目的:创建并验证急性心力衰竭(AHF)患者发生1型心肾综合征(CRS)的预警评分。方法:对1 709例AHF病例进行回顾性分析,随机选取60%的病例(1 010例)进行Logistic回归分析并创建预警评分,其余40%(699例)进行验证。结果:AHF患者1型CRS的发病率为32.2%。年龄≥70岁、反复心力衰竭史、收缩压<90mmHg(1mmHg=0.133kPa)、血钠<130mmol/L、心功能Ⅳ级、蛋白尿、基线血肌酐(SCr)≥104μmol/L及静脉呋塞米最大日剂量≥80mg/d是1型CRS发生的独立危险因素。依据各危险因素β偏回归系数并结合临床建立预警评分,评分最佳诊断分界点为8分,≥8分的患者1型CRS发病率较<8分患者显著增加(55.1%︰18.0%,P<0.01)。经验证该预警评分具有较好的鉴别力及校准度。结论:本研究所创建的预警评分能有效地预测AHF患者1型CRS的发生,可供临床应用。
OBJECTIVE: To create and validate an early warning score of type 1 cardiorespiratory syndrome (CRS) in patients with acute heart failure (AHF). Methods: A total of 1 709 cases of AHF were retrospectively analyzed. Logistic regression analysis and early warning score were established in 60% (10 010 cases) randomly, and the remaining 40% (699 cases) were verified. Results: The incidence of type 1 CRS in AHF patients was 32.2%. Age ≥70 years, history of repeated heart failure, systolic blood pressure <90mmHg (1mmHg = 0.133kPa), serum sodium <130mmol / L, cardiac function grade Ⅳ, proteinuria, baseline serum creatinine (SCr) ≥ 104μmol / The maximum daily dose of rice ≥ 80mg / d is an independent risk factor for type 1 CRS. According to the β partial regression coefficient of each risk factor and the clinical establishment of early warning score, the best diagnostic cutoff point was 8 points. The incidence of type 1 CRS was significantly higher than that of patients <8 (55.1%: 18.0%, P <0.01). The early warning score has been verified with good discrimination and calibration. Conclusion: The early warning score created in this study can effectively predict the occurrence of type 1 CRS in patients with AHF for clinical use.