摘要
目的 探讨胱抑素C与老年心力衰竭患者6个月死亡和再住院的关系。方法 本研究使用自贡心力衰竭研究的数据。自贡心力衰竭研究是一项回顾性队列研究,选取2016年12月至2019年6月自贡市第四人民医院收治的心力衰竭患者1786例,根据胱抑素C水平的三分位数分为三分位数1组[(1.10±0.17)mg/L]587例、三分位数2组[(1.60±0.17)mg/L]599例、三分位数3组[(2.91±0.90)mg/L]600例。主要终点为出院后6个月死亡和心力衰竭再住院复合终点。采用多因素Cox比例风险回归分析胱抑素C水平与6个月死亡和心力衰竭再住院复合终点的关系,采用限制性立方样条图分析胱抑素C水平与6个月死亡和心力衰竭再住院复合终点的关系,采用Kaplan-Meier生存曲线分析3组6个月无事件生存率差异,采用ROC曲线分析胱抑素C水平对6个月死亡和心力衰竭再住院复合终点的预测价值。结果 多因素Cox比例风险回归分析显示,三分位数2组、三分位数3组是心力衰竭患者6个月死亡和再住院复合终点的危险因素(HR=1.170,95%CI:0.970~1.390,P=0.111;HR=1.452,95%CI:1.190~1.756,P=0.000)。当将胱抑素C水平作为连续变量进行分析时,结果保持一致:胱抑素C水平每增加1个标准差,复合终点风险增加1.141(HR=1.141,95%CI:1.060~1.226);每增加1 mg/L,复合终点风险增加1.152(HR=1.152,95%CI:1.057~1.250)。限制性立方样条图显示,胱抑素C水平与6个月死亡和心力衰竭再住院复合终点之间呈非线性的反J形关系,其风险拐点为2.13 mg/L。ROC曲线分析显示,胱抑素C水平预测6个月死亡和心力衰竭再住院复合终点,以及单独死亡和心力衰竭再住院风险的曲线下面积分别为0.572、0.667、0.554。结论 胱抑素C升高与老年心力衰竭患者6个月死亡和再住院复合终点风险独立相关。
Objective To investigate the association between cystatin C level and 6-month mortali-ty as well as re-hospitalization in elderly patients with heart failure(HF).Methods The clinical data in this study were from a retrospective cohort study,Zigong Heart Failure Study.A total of 1786 elderly HF patients admitted in Zigong Fourth People's Hospital from December 2016 to June 2019 were selected.According to the tertiles of cystatin C level,the subjected patients were divided into three groups,with the cystatin C level of 1.10±0.17(587 cases),1.60±0.17(599 cases),and 2.91±0.90 mg/L(600 cases),respectively.The primary endpoint was a composite end-point of death at 6 months after discharge and readmission due to HF.Multivariate Cox propor-tional hazards regression analysis was employed to analyze the relationship of the cystatin C level with the composite endpoint of 6-month mortality and readmission due to HF.Restricted cubic spline was used to model the relationship between the cystatin C level and the composite end-point,Kaplan-Meier survival curve was plotted to analyze the differences in 6-month event free survival rates among the three groups,and ROC curve was drawn to analyze the predictive value of cystatin C level for the composite endpoint.Results Multivariate Cox proportional hazards re-gression analysis showed that the middle and upper tertiles of cystatin C level were risk factors for the composite endpoint of 6-month mortality and readmission due to HF(HR=1.170,95%CI:0.970-1.390,P=0.111;HR=1.452,95%CI:1.190-1.756,P=0.000).When taking cystatin.C level as a continuous variable,the results remained consistent:for every one standard deviation increase in cystatin C level,HR=1.141,95%CI:1.060-1.226 in Model 3;For every 1 mg/L in-crease,HR=1.152,95%CI:1.057-1.250 in Model 3.Restricted cubic spline displayed a non-linear inverse J-shaped relationship between cystatin C level and the composite endpoint of 6-month mortality and readmission due to HF,with a risk inflection point of cystatin C level at 2.13 mg/L.ROC curve analysis showed that the AUC value of cystatin C level in predicting the composite endpoint,6-month death and re-admission due to HF was 0.572,0.667 and 0.554,respectively.Conclusion Elevated cystatin C level is independently associated with an increased risk of the composite endpoint of 6-month death and re-admission in elderly HF patients.
作者
李珊
付治卿
安莉
张帷
司全金
Li Shan;Fu Zhiqing;An Li;Zhang Wei;Si Quanjin(Third De partment of Healthcare,Second Medical Center,Chinese PLA General Hospital,Beijing 100143,China)
出处
《中华老年心脑血管病杂志》
北大核心
2025年第6期732-737,共6页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2024016)。
关键词
老年人
心力衰竭
回归分析
预测
aged
heart failure
regression analysis
forecasting
