老年慢性心力衰竭住院患者衰弱的危险因素分析与预测模型构建-现代医学

老年慢性心力衰竭住院患者衰弱的危险因素分析与预测模型构建

作者：吴丹袁娟

单位：南京医科大学附属脑科医院心血管内科, 江苏南京 210029

分类号：R473.5

出版年·卷·期（页码）：2025·53·第二期（300-307）

摘要：

目的：探讨老年慢性心力衰竭(CHF)患者出现衰弱的危险因素并构建相应的预测模型。方法：回顾性分析2022年1月至2024年6月于南京医科大学附属脑科医院住院治疗的214例老年CHF患者的临床资料，根据是否发生衰弱分为衰弱组(n=59)和非衰弱组(n=155)。比较两组临床风险因素，多因素Logistic回归分析进一步明确独立危险因素，根据结果构建预测模型，绘制ROC曲线分析模型的预测价值。结果：本研究纳入214例老年CHF患者，衰弱发生率为27.57%(59/214)。多因素Logistic回归分析结果显示，年龄＞80岁、糖尿病、COPD、睡眠障碍、NYHA心功能分级Ⅲ/Ⅳ级、CHF病程≥10年、服药依从性较差、合并症≥3个、NRS-2002评分≥3分以及LVEF＜52%是老年CHF患者发生衰弱的独立危险因素。回归模型的ROC曲线下面积为0.802(95%CI：0.709～0.895)，灵敏度和特异度分别为0.79和0.81。结论：根据老年CHF患者发生衰弱的风险因素构建的风险预测模型对老年CHF护理有较大参考价值，可为临床早期识别高危患者并实施针对性护理干预提供依据。

Objective: To investigate the risk factors for frailty in elderly patients with chronic heart failure(CHF) and to develop a corresponding predictive model. Methods: A retrospective analysis was conducted on the clinical data of 214 elderly CHF patients who were hospitalized in Brain Hospital Affiliated to Nanjing Medical University from January 2022 to June 2024. Based on the occurrence of frailty, the patients were divided into a frail group(n=59) and a non-frail group(n=155). Clinical risk factors were compared between the two groups, and a multivariate logistic regression analysis was performed to identify independent risk factors. Based on the results, a predictive model was developed, and an ROC curve was plotted to assess the model's predictive value. Results: This study included 214 elderly CHF patients, with a frailty incidence of 27.57%(59/214). The results of the multivariate logistic regression analysis indicated that age>80 years, diabetes, COPD, sleep disorders, NYHA heart function classification Ⅲ/Ⅳ, CHF duration ≥ 10 years, poor medication adherence, ≥ 3 comorbidities, NRS-2002 score ≥ 3, and LVEF<52% were independent risk factors for frailty in elderly CHF patients. The area under the ROC curve for the regression model was 0.802(95%CI:0.709-0.895), with a sensitivity of 0.79 and a specificity of 0.81. Conclusion: The risk prediction model based on the risk factors for frailty in elderly CHF patients holds significant reference value for the care of elderly CHF patients, which can provide a basis for the early identification of high-risk patients in clinical settings and the implementation of targeted nursing interventions.

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