Cox比例风险模型分析影响心力衰竭预后的因素

Cox proportional hazards model for prognostic factors of heart failure

摘要:

目的 探讨影响心力衰竭（HF）患者预后的因素。方法 回顾性地分析2007年1月至2010年12月兰州大学第一医院心内科收治住院的556例HF患者的临床资料，并进行电话随访。根据患者是否死亡将所有研究对象分为存活组（n＝282）和死亡组（n＝231），并对两组的各项指标进行分析比较。Cox比例风险模型评价影响患者死亡风险的因素。结果 共纳入分析患者513例，截止随访结束，死亡231例，占45%；死亡组患者入院时空腹血糖、总胆红素、直接胆红素、肌酐明显高于存活组（P＜0.05）；血红蛋白、血钠离子浓度、血钙离子浓度、总胆固醇、左室射血分数（LVEF）、缩短分数明显低于存活组（P＜0.05）；多因素Cox比例风险模型分析显示年龄（RR＝1.030）、住院天数（RR＝1.014）、LVEF（RR＝0.988）、并发症（RR＝1.102）、空腹血糖（RR＝1.060）、总胆红素（RR＝1.004）异常是预测患者死亡风险的独立危险因素（P＜0.05）。结论 HF总体死亡率高，预后差；LVEF、总胆红素、空腹血糖等指标异常是影响患者预后的主要危险因素。

Abstract:

Objective To determine the prognostic factors in patients with heart failure (HF). Methods Clinical data of 556 HF patients admitted in our department from January 2007 to December 2010 were collected and retrospectively analyzed. All patients were followed up through telephone calls to know their final outcome. Then, they were classified into 2 groups: survival group (n＝282) and death group (n＝231). The 2 groups were compared in their clinical indices. Cox proportional hazards model was used to evaluate the mortality hazard ratio of different factors. Results A total of 513 HF patients were finally enrolled, and the other 35 were lost of follow-up. The mortality rate was 45%(231/513) in this group. Fasting blood glucose, total bilirubin, direct bilirubin, and creatinine at hospital admission were significantly higher in the dead group than in the survival group (P＜0.05). While, hemoglobin, sodium ion concentration, calcium ion concentration, total cholesterol, left ventricular ejection fraction (LVEF), and fractional shortening at the admission were significantly lower in the dead group than in the survival group (P＜0.05). In multivariable analysis, age (RR＝1.030), hospital stay (RR＝1.014), LVEF (RR＝0.988), complications (RR＝1.102), fasting blood glucose (RR＝1.060), and total bilirubin (RR＝1.004) were determined as the independent risk factors of mortality (P＜0.05). Conclusion Heart failure is of poor prognosis and high mortality rate. Abnormalities in LVEF, fasting blood glucose and total bilirubin are main factors influencing the prognosis of HF.