心力衰竭患者住院病死率15年趋势分析

目的调查15年间心力衰竭住院患者在院30 d病死率的变化趋势和住院日情况。方法选择1993年1月1日至2007年12月31日15年间的心力衰竭住院患者7319例(男4543例,女2776例),统计心力衰竭住院患者在院病死率及住院日,采用Kaplan-Meier生存曲线统计不同时段的生存时间。结果 15年间心力衰竭住院患者年龄呈增长趋势(P=0.000),平均住院日呈下降趋势(P=0.000)。在院30 d病死率从1993—1997年的7.0%,到1998—2002年的4.5%,再到2003—2007年的5.1%(P=0.002)。不同性别在不同时段的在院病死率差异无统计学意义。以心肌梗死、瓣膜性心脏病为病因的心力衰竭患者在院病死率下降极为显著(P<0.01)。Kaplan-Meier生存曲线显示,时段与病死率相关(2003—2007年比1993—1997年,HR 0.59,95%CI 0.46～0.76,P<0.001)。结论调整年龄后心力衰竭住院患者在研究时段30 d在院病死率呈显著下降趋势,平均住院日呈下降趋势,住院患者年龄呈显著增高趋势。     

心力衰竭住院患者肾功能恶化的危险因素分析

目的了解心力衰竭住院患者肾功能恶化发生率、病死率及独立危险因素。方法回顾性分析初次有效诊断充血性心力衰竭患者625例(男356例,女259例)。将患者分为2组:肾功能恶化组WRF(+),肾功能正常组WRF(-),比较两组间基本临床资料,肾功能恶化发病率、在院30天病死率和药物治疗,通过Logistic回归模型分析心力衰竭住院患者肾功能恶化的独立危险因素。结果心力衰竭住院患者肾功能恶化发病率为22.7%(P=0.000);与肾功能正常组比较,住院时间延长(P=0.017),在院30天病死率显著增高(15.6%vs.6.9%,P=0.001);Logistic回归分析显示年龄(P<0.001),心功能Ⅲ～Ⅳ级(P=0.023),糖尿病(P=0.020),血红蛋白(Hb)(P<0.001)、肌酐(Cr)(P<0.001)、肌酐清除率(GFR)〔HR1.85,95%CI(1.43-2.40),P<0.001〕是肾功能恶化的独立危险因素。结论心力衰竭住院患者肾功能恶化发生率相对常见,年龄,心功能Ⅲ～Ⅳ级,糖尿病,血红蛋白,肌酐,肌酐清除率是肾功能恶化的独立危险因素。     

心衰合并房颤的老年患者1年内再住院风险因素分析及预测模型的建立

目的 探索心衰合并房颤的老年患者1年内再住院进行治疗的风险因素，并构建风险预测模型。方法 回顾性分析2018年1月—2022年1月在复旦大学附属华东医院治疗的129例老年房颤合并心衰患者的临床资料，依据1年内有无再次住院分为未再住院组(n=72)和再住院组(n=57)。采用单因素、多因素回归分析法分析2组患者的临床、实验室及影像学指标值，筛选出心衰合并房颤的老年患者再住院的独立危险因素。根据筛选结果，构建综合的诺莫图风险预测模型，计算不同单一模型及综合模型的诊断效能，通过ROC曲线和曲线下面积进行风险因素评估。结果 根据单因素、多因素逻辑回归模型筛选显示，BMI(OR=1.419, 95%CI:1.165～1.729,P=0.001)、出院后服药依从性(OR=4.604, 95%CI:1.165～19.484,P=0.038)、高血压(OR=3.380, 95%CI:1.230～9.290,P=0.018)和NT-proBNP(OR=2.956, 95%CI:1.781～5.085,P<0.001)为心衰合并房颤的老年患者1年内再住院的独立危险因素。其中NT-proBNP和BMI...     

SDF-1α可能是胃癌淋巴结转移的独立危险因素

目的:探讨间质细胞衍生因子-1α(stromal cell-derived factor-1α,SDF-1α)的表达与胃癌淋巴结转移的关系.方法:应用免疫组织化学检测SDF-1α在152例胃癌组织中的表达,将表达结果与患者临床病理特征进行相关性分析,并对胃癌淋巴结的转移危险因素进行单因素分析和多因素分析.结果:SDF-1α表达与肿瘤淋巴管浸润(P=0.016)和淋巴结转移(P=0.003)密切相关,而与患者年龄、性别、肿瘤部位、肿瘤大小、大体分型、浸润深度和组织分化程度(P0.05)等无相关性;未分化的组织学(HR=3.312;95%CI:1.414-7.825,P=0.008)、淋巴管浸润(HR=11.215;95%CI:2.780-45.978,P=0.002)和S D F-1α(H R=3.194;95%C I:1.313-7.296,P=0.013)是胃癌患者的危险因素;未分化的组织学(HR=3.054;95%CI:1.176-8.614,P=0.039)、淋巴管浸润(H R=8.651;95%CI:1.731-44.959,P=0.008)和SDF-1α(HR=2.219;95%CI:1.327-10.346,P=0.015)是胃癌患者淋巴结转移的独立危险因素.结论:SDF-1α可能是胃癌患者淋巴结转移的独立危险因素.     

慢性心力衰竭患者肾功能恶化的危险因素分析

目的 研究慢性心力衰竭(心衰)患者肾功能恶化的危险因素及其对预后的影响.方法 采用病例对照研究方法,分析与肾功能恶化发生有统计学关联的独立危险因素,同时观察肾功能恶化对预后的影响.结果 住院心衰患者肾功能恶化发生率31%,入院肌酐水平及心功能分级与肾功能恶化的发生独立相关,OR值分别为2.248(95%CI1.088～4.647,P=0.029)和2.485(95%CI1.385～4.459.P＝0.002).发生肾功能恶化的患者住院期间病死率明显高于对照组(16.7%比2.1%,P=0.000),调整混杂因素后,肾功能恶化是死亡的独立危险因素,OR值3.824(95%CI2.452～5.137.P＜0.015).结论 肾功能恶化在住院心衰患者中发生率较高,与住院期间病死率明显相关.入院肌酐水平偏高及心功能差为发生肾功能恶化的独立危险因素.

Abstract：

Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P ＜0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.     

慢性心力衰竭患者性别差异对预后的影响因素研究

目的对慢性心力衰竭(心衰)患者进行随访,评估其病因、合并疾病、临床特征与心衰预后指标的相关性,分析性别差异对患者预后影响的相关危险因素。方法连续纳入慢性心衰患者228例,每3个月门诊随访,收集临床资料、心脏超声参数等。记录患者心衰再入院、心源性死亡以及全因死亡终点发生情况。分析在不同性别中不良预后的相关危险因素。结果与男性比较,女性年龄偏大,合并高血压、心房颤动、慢性肾脏病和舒张功能不全明显升高(P<0.01)。对影响预后因素分析显示,女性心房颤动是心衰复发的独立危险因素(OR=6.874,95%CI:1.932²4.459,P=0.003),急性期LVEF降低和肺动脉压力升高是心源性死亡的独立危险因素(OR=0.917,95%CI:0.85124.459,P=0.003),急性期LVEF降低和肺动脉压力升高是心源性死亡的独立危险因素(OR=0.917,95%CI:0.851⁰.989,P=0.024;OR=1.107,95%CI:1.0210.989,P=0.024;OR=1.107,95%CI:1.021¹.200,P=0.013),稳定期心功能分级是全因死亡的独立危险因素(OR=12.484,95%CI:1.1171.200,P=0.013),稳定期心功能分级是全因死亡的独立危险因素(OR=12.484,95%CI:1.117¹39.495,P=0.040)。结论慢性心衰预后的危险因素存在性别差异。对女性患者控制心房颤动、优化舒张性心衰治疗对减少心衰复发,降低心源性死亡可能较男性更有意义。     

老年女性急性ST段抬高型心肌梗死患者远期预后的影响

目的探讨老年女性急性ST段抬高型心肌梗死(STEMI)患者远期预后的影响。方法入选我院住院明确诊断为急性STEMI的老年患者287例,按性别分为男性组190例,女性组97例。比较2组患者的临床特点、住院期间及远期主要不良心脑血管事件(MACCE)。结果与男性组比较,女性组平均年龄、高血压、LDL-C、空腹血糖水平明显升高,吸烟、血肌酐、血管病变支数比例显著降低(P<0.05,P<0.01)。2组远期MACCE发生率比较无显著差异(23.4%vs 18.6%,P=0.639)。Cox回归分析显示,高血压(HR=1.954,95%CI:1.058~3.608,P=0.032)、Killip分级(HR=2.017,95%CI:1.454~2.798,P=0.000)、术后TIMI分级(HR=0.552,95%CI:0.422~0.723,P=0.000)及急诊PCI(HR=0.240,95%CI:0.112~0.513,P=0.000)是老年STEMI患者远期MACCE的独立预测因素。结论老年STEMI患者近、远期预后无性别差异,提示性别可能不是老年STEMI患者远期预后的独立预测因素,而高血压、Killip分级、术后TIMI分级及急诊PCI能独立预测老年STEMI患者远期转归。     

LT3S与急性心力衰竭患者病情的相关性及其对短期预后的预测价值

目的:观察和分析低三碘甲状腺原氨酸综合征（LT3S）对判断急性心力衰竭（AHF）患者病情危重程度和预测短期内死亡风险的临床价值。方法: 入选240例AHF患者,对其进行疾病严重程度指数APACHE II评分,检测其脑钠尿肽（BNP）水平、甲状腺功能。统计患者住院期间病死率,电话随访患者出院6个月后的生存情况。结果: 入选240例AHF患者中,并发的患者70例,发生率为29.2%;并发LT3S与并发非LT3S AHF患者间APACHE II评分、BNP水平、住院期间病死率和随访期间病死率差异均有统计学意义［(24±6) vs.(20±6);(784±188) mg/L vs.(697±200) mg/L;17.1% vs. 7.6%;11.3% vs. 3.4%,均P<0.05］。Cox回归风险比例模型分析:游离三碘甲状腺原氨酸(FT3)水平、APACHE II评分和BNP水平是AHF患者短期内死亡的影响因素(标准偏回归系数=-0.872,HR=0.683,95%CI:0.536-0.847,P<0.05;标准偏回归系数=1.531,HR=1.257,95%CI:1.317-1.864,P<0.05;标准偏回归系数=0.417,HR=0.997, 95%CI:0.922-1,P<0.05)。受试者工作特征曲线(ROC)下面积(AUC)分析:APACHE II评分的AUC大于BNP水平和FT3水平的AUC;而BNP水平和FT3水平的AUC间的差异无统计学意义(0.893,95%CI:0.831-0.965;0.720, 95%CI:0.640-0.806;0.698,95%CI:0.586-0.751)。结论: AHF患者伴LT3S的诊断,对预测患者的病情危重程度和预后有重要价值。     

用倾向性评分匹配法分析SGLT-2和ARNI对心衰预后影响

目的 基于倾向性评分匹配法分析SGLT-2和ARNI对心衰患者的预后影响。方法 选取2018年6月至2021年12月山西医科大学第一医院诊断的心力衰竭患者369例，根据治疗方法分为达格列净组和沙库巴曲缬沙坦组，两组匹配后比较预后并分析影响因素。采用SPSS 26.0和R Studio( 4.1.2版本)进行数据分析。根据数据类型，组间比较分别采用t检验、秩和检验、χ2或Fisher精确概率法。Cox回归模型分析影响因素并绘制Kaplan-Meier曲线。结果 匹配后每组70例，Kaplan-Meier曲线示两组心衰再住院无差异（P=0.19）。Cox多因素分析显示，达格列净组NYHA分级（HR＝6.923，95%CI=1.032~46.426，P=0.046）、LVEDD（HR＝1.139，95%CI=1.004~1.293，P=0.044）、标准化Z值的NT-proBNP（HR＝1.825，95%CI=1.075~3.097，P=0.026）、饮酒（HR＝0.086，95%CI=0.018~0.413，P=0.002）和HDL-C（HR＝0.012，95%CI=0.000~0.642，P=0.029）是预后影响因素；沙库巴曲缬沙坦组吸烟（HR＝14.376，95%CI=1.657~124.748，P=0.016）、饮酒（HR＝0.082，95%CI=0.012~0.578，P=0.012）和血红蛋白（HR＝0.953，95%CI=0.912~0.995，P=0.030）是预后影响因素。结论 倾向性评分匹配后，达格列净和沙库巴曲缬沙坦对心衰预后无显著差异并得出相关影响因素。     

急性脑梗死并发全身炎性反应综合征的危险因素分析及对患者预后的影响

目的研究急性脑梗死(ACI)患者全身炎性反应综合征(SIRS)的发生率、相关危险因素及对患者预后的影响。方法选择我院神经内科住院的ACI患者218例,发生SIRS 50例,占22.9%,并分为SIRS组50例,非SIRS组168例,3个月后,用改良Rankin量表(mRS)评分判断预后。采用单因素分析和多因素logistic回归分析相关危险因素。结果 SIRS组患者年龄、C反应蛋白、空腹血糖、入院美国国立卫生研究院卒中量表(NIHSS)评分均明显高于非SIRS组,差异有统计学意义(P0.01)。多因素logistic回归分析显示,C反应蛋白(OR=1.176,95%CI:1.116~1.240,P=0.000)、入院NIHSS评分(OR=1.160,95%CI:1.112~1.210,P=0.000)及空腹血糖(OR=1.152,95%CI:1.042~1.274,P=0.006)是ACI并发SIRS的独立危险因素。SIRS组患者3个月mRS评分[(4.1±1.2)分vs(3.1±1.0)分,P0.01]和病死率(38.0%vs 9.5%,P0.01)较非SIRS组高。结论 ACI患者SIRS发生率高,预后不良,C反应蛋白、入院NIHSS评分及空腹血糖是SIRS发生的独立危险因素。     

肾功能不全对慢性心力衰竭住院患者预后影响的回顾性分析

目的 回顾性分析肾功能不全对慢性心力衰竭(心衰)住院患者预后的影响.方法收集天津医科大学第二医院心脏科1980年1月至2007年8月慢性心衰住院病例,根据肾小球滤过率将全部患者分为A(肾功能正常)、B(肾功能轻度受损)、C(肾功能不全)三组;C组患者以入院年代分为D(1980年1月至1989年12月)、E(1990年1月至1999年12月)、F(2000年1月至2007年8月)三个亚组.分析临床特点及治疗情况.应用logistic回归法对其预后影响因素进行分析.结果分析2459例病例,其中合并肾功能不伞者714例(29.0%).与A、B组的患者相比,C组患者年龄较大,心功能较差,治疗仍以硝酸酯、利尿剂、洋地黄为主,血管紧张素Ⅱ受体拈抗剂、β受体阻滞剂、他汀类药物使用逐年代增加,血管紧张素转换酶抑制剂以20世纪90年代应用比例最高,且住院时间长、住院全因病死率高(均为P＜0.01),使用多变量分析校正其他危险因素后,肾功能不全是增加慢性心衰住院患者病死率的独立危险因素,肾小球滤过率每下降10 ml·min-1·1.73 m-2,病死率增加16.7%.结论慢性心衰合并肾功能不全的发生率较高,且住院时间长、住院病死率高,肾功能不全是增加慢性心衰患者住院病死率的独立危险因素,血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、他汀类药物的应用对于改善患者的预后可能具有重要意义.     

Impact of clinical and echocardiographic parameters assessed during acute decompensation of chronic heart failure on 3-year survival

BACKGROUND: It is unclear whether established risk factors affecting the prognosis of chronic heart failure (CHF) have the same predictive value when assessed during acute haemodynamic decompensation of CHF. AIM: To investigate the impact of selected clinical and echocardiographic parameters assessed in patients with CHF during emergency admission due to acute CHF decompensation, on 3-year survival. METHODS: This retrospective study involved 100 consecutive patients with CHF (60 women and 40 men at the mean age of 70.4+/-9.8 years), admitted to hospital due to angina pectoris symptoms or pulmonary oedema. In the echocardiographic study performed within the first 48 hours of in-hospital stay, standard parameters as well as right ventricular systolic pressure (RVSP) were evaluated. In order to identify biological, clinical and echocardiographic factors affecting 3-year survival, both uni- and multivariable Cox proportional hazards regression analyses were carried out. RESULTS: Forty-four patients died during 3-year follow-up. Univariate regression analysis revealed that age >60 years, sodium serum concentration <140 mmol/L, RVSP >35 mmHg and reduced left ventricular ejection fraction <50% were associated with an increased risk of death. However, multivariate regression analysis showed that only age and sodium concentration were independent risk factors. CONCLUSIONS: Age of over 60 years and sodium concentration below 140 mmol/L seen during acute decompensation were found to be independent predictors of unfavourable outcome in terms of mortality in 3-year follow-up of patients with CHF.     

High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure

OBJECTIVES: The aim of this study was to evaluate whether repetitive measurements of plasma levels of neurohumoral factors and cytokines before and after additional treatment are useful for predicting mortality in patients with congestive heart failure (CHF). BACKGROUND: Neurohumoral and immune activation play an important role in the pathophysiology of CHF. However, the effects of serial changes in these factors on the prognostic value remain unknown. METHODS: We measured plasma levels of neurohumoral factors and cytokines and left ventricular ejection fraction (LVEF) before and three months after optimized treatment for CHF in 102 consecutive patients with severe CHF (New York Heart Association class III to IV) on admission to our hospital. Physicians who were blind to the plasma neurohumoral factors until study completion treated patients using standard drugs. Patients were monitored for a mean follow-up period of 807 days. RESULTS: Plasma levels of neurohumoral factors, cytokines and LVEF were significantly improved three months after optimized treatment. Cardiac death occurred in 26 patients. Among 19 variables including LVEF, only a high level of brain natriuretic peptide (BNP) and interleukin-6 (IL-6) at three months after optimized treatment showed significant independent relationships by Cox proportional hazard analysis with a high mortality for patients with CHF. CONCLUSIONS: These findings indicate that high plasma BNP and IL-6 levels three months after optimized treatment are independent risk factors for mortality in patients with CHF, suggesting that sustained high plasma levels of BNP and IL-6 after additional standard treatment were independent risk factors for mortality in patients with CHF despite improvements in LVEF and symptoms.     

血红蛋白、胆红素在预测心衰患者全因死亡风险中的作用

目的研究血红蛋白浓度（Hb）及总胆红素水平（Tbil）是否能预测慢性心衰患者全因死亡。方法对入选的1197例慢性心力衰竭（CHF）患者进行随访,全因死亡为随访终点。先比较不同Hb及Tbil水平其他临床指标分布的差异;再应用Kaplan-Meier曲线及Log-rank检验进行不同水平生存描述及比较;单因素Cox回归判断各影响因素与心衰死亡的关系,将有统计学意义的指标引入多元Cox回归,以明确低Hb、高Tbil是否为心衰死亡的独立预测因子。结果完成随访1025例（失访率14.4%）,死亡360例（35.1%）。随访中位数44个月。不同Hb及BMI水平的心衰患者在合并症、血压、左室射血分数（LVEF）、多种检验项目及用药方面存在显著差异。随着Hb减低及Tbil增高,死亡率增加。单因素分析显示,总胆红素（Tbil）、肌酐、尿酸（UA）升高以及血红蛋白（Hb）、血钠（Na）降低均可增加心衰患者死亡风险。校正其他影响因素后,Hb、Tbil、Scr和UA与心衰死亡独立相关,Hb减低（HR1.142）及Tbil〉19umol/L（HR1.312）均为心衰患者死亡的独立预测因素。结论 Hb、Tbil和UA与心衰死亡独立相关,Hb降低和Tbil升高均为心衰死亡的独立预测因素。     

Impact and Outcomes of Patients with Congestive Heart Failure Complicating Non-ST-Segment Elevation Myocardial Infarction,Results from a Nationally-Representative United States Cohort

IntroductionCongestive heart failure (CHF) is seen in up to 13–25% of patients with NSTEMI. Recent data describing the impact of congestive heart failure (CHF) on in-hospital outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) in the United States is limited. We sought to examine the in-hospital outcomes, and management of CHF in patients admitted to the hospital with NSTEMI.MethodsNational Inpatient Sample (NIS) database (2010–2014) was analyzed to identify patients with NSTEMI using ICD-9-CM codes. The primary outcome was in-hospital mortality. Propensity score-matching analysis compared mortality in CHF patients to matched controls without CHF.ResultsOf 247,624 patients with NSTEMI, 84,115 (34%) had CHF. Patients with CHF were less likely to receive percutaneous coronary intervention (PCI) [20.48% vs. 40.9%, P < 0.001] or coronary artery bypass grafting (CABG) [8.2% vs 9.6%, P < 0.001] during hospitalization. Also, they had longer lengths of stay and higher risk for in-hospital adverse outcomes. CHF was the strongest predictor of in-hospital death. The increased mortality risk was persistent after propensity matching (RR 1.27; 95% CI 1.22 to 1.33).ConclusionCHF among patients with NSTEMI is associated with increased risk for in-hospital mortality and adverse outcomes.     

Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction

Inferior myocardial infarction (MI) is considered to have a more favorable prognosis than anterior wall MI but includes high risk groups with increased mortality and morbidity. It is well known that congestive heart failure (CHF) complicating acute MI has poor prognosis. In this study we assessed the clinical and prognostic significance of CHF and the predictive value of the baseline demographic and clinical variables for CHF in patients with acute inferior MI. A total of 350 patients with acute inferior MI were included. In group A there were 26 patients (7.4%) with CHF, and in group B there were 324 patients (92.6%) without this complication. Baseline clinical and demographic characteristics and in-hospital complications of the groups were assessed. In group A patients were older (67.6±9.5 vs 53.7±10.9 years, p<0.0001) and there were more female patients (50% vs 15%, p<0.00001) compared to group B. The prevalence of diabetes mellitus (58% vs 16%) and precordial ST segment depression on admission ECG (81% vs 50%) were significantly higher in group A compared to group B (p<0.00001 and p=0.002 consecutively). In group A there was a higher rate of righ ventricular (25% vs 23%), posterior (26% vs 24%) and posterolateral myocardial infarction (19% vs 14%), but the differences were not statistically different. In group A patients had significantly higher rate of second- or third-degree AV block (46% vs 8%, p<0.00001), cardiogenic shock (35% vs 1%, p<0.00001) and mortality (46% vs 3%, p<0.00001) compared to group B. In a multivariate regression analysis diabetes mellitus (p=0.0003) and precordial ST segment depression on admission ECG (p=0.002) were found as the independent predictors of in-hospital CHF in patients with acute inferior MI. CHF and ST segment depression on admission ECG were found as the independent predictors of in-hospital mortality (p<0.00001, p=0.04 consecutively). Patients with CHF complicating acute inferior MI have more unfavorable demographic and clinical characteristics on admission, higher rate of in-hospital complications and mortality. History of diabetes mellitus and precordial ST segment depression on admission ECG have an independent predictive value for CHF in this particular group of patients.     

中国急性心肌梗死患者住院期间死亡的危险因素分析

目的:探讨当代中国急性心肌梗死(AMI)患者住院期间死亡的危险因素。方法:纳入2013年01月至2014年09月中国急性心肌梗死(CAMI)注册登记研究的AMI患者23417例[其中5795例非ST段抬高型心肌梗死(NSTEMI)患者和17622例ST段抬高型心肌梗死(STEMI)患者]。1504例患者在住院期间死亡,为死亡组,余住院期间生存的21913例患者为生存组。收集患者基线资料、实验室检查、治疗方法、院内结局等临床资料,以住院期间死亡为主要终点构建多因素Logistic回归模型,探讨AMI患者住院期间死亡的独立危险因素。结果:6.42%(1504/23417)的AMI患者在住院期间死亡。与生存组比较,死亡组患者年龄更大,女性患者更多,体重指数更低,合并糖尿病、高血压的比例更高,Killip心功能分级更高,并发症更多,并且更易出现心脏骤停(P均<0.05)。多因素Logistic回归分析结果提示,年龄、性别、体重指数、收缩压、心率、血肌酐水平、白细胞计数、血清钾浓度、血清钠浓度、STEMI、前壁心肌梗死、心脏骤停、Killip心功能分级、高血压、高脂血症及吸烟史是预测患者住院期间死亡的独立危险因素。结论:本研究发现16个当代中国AMI患者住院期间死亡的独立危险因素,有助于临床医师早期识别高危患者并选择最佳诊疗策略。     

内源性促红细胞生成素对慢性心力衰竭患者预后的影响

目的了解内源性促红细胞生成素(EPO)对慢性心力衰竭(CHF)患者预后的判定价值。方法选择住院的CHF患者115例,以患者是否存活分为死亡组55例,存活组60例。另选同期住院的年龄、性别相匹配的非CHF患者67例为对照组,以便建立logEPO和血红蛋白(Hb)的回归方程。对CHF患者进行全因死亡和因心力衰竭再次入院的随访观察,测定血EPO,并进行分析。结果与存活组比较,死亡组高龄患者多、心功能(NYHA)Ⅱ级比例低、Hb降低和B型钠尿肽(BNP)水平升高(P<0.01)。Kaplan-Meier生存曲线显示,贫血的CHF患者病死率增高(RR=2.50,95%CI:1.38～4.54,P=0.002)。ROC曲线评估EPO和BNP预测CHF患者死亡的最佳界值分别为44.4 U/L和752 ug/L(P=0.036,=0.000)。年龄、Hb、BNP和NYHA对CHF患者全因死亡有独立预测价值;而男性、BNP和Hb水平对因心力衰竭再次入院有独立预测价值。贫血的CHF患者EPO是独立于Hb的全因死亡的强预测指标(RR=2.86,95%CI:1.18～6.94,P=0.020)。结论贫血是CHF患者不良预后的独立预测因素。EPO是贫血CHF患者全因死亡的独立预测指标。     

Low pulse pressure is independently related to elevated natriuretic peptides and increased mortality in advanced chronic heart failure.

AIMS: An increased pulse pressure (PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure (CHF). In contrast, a decreased PP was related to increased mortality in patients with acute decompensated heart failure. However, the predictive value of PP in patients with advanced CHF is not known. METHODS AND RESULTS: PP was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with New York Heart Association Class III or IV CHF (mean age 65 and mean ejection fraction 0.26). Natriuretic peptides were measured in a subgroup. Multivariable Cox-regression analysis demonstrated that lower PP was associated with an increased mortality [hazard ratio (HR) 0.91 per 10 mmHg; 0.93-0.99], independent of mean arterial pressure (MAP) and other well known prognostic markers. In patients with a PP below the median value of 45 mmHg, PP was a stronger predictor of mortality than MAP (HR for PP 0.80 per 10 mmHg; 0.64-0.99). In patients with a PP above the median value of 45 mmHg, MAP was a stronger predictor of mortality than PP (HR for MAP 0.83 per 10 mmHg increase; 0.72-0.95). In addition, lower PP was independently related to increased atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP). CONCLUSION: In patients with advanced CHF, low PP is an independent predictor of mortality. In addition, low PP was related to increased levels of ANP and BNP.     

Comprehensive complexity assessment as a key tool for the prediction of in-hospital mortality in heart failure of aged patients admitted to internal medicine wards

Congestive heart failure (CHF) and cognitive impairment are both common problems in old age, associated with significant mortality, impaired quality of life and disability. This study evaluated patients with CHF, admitted to internal medicine and geriatric wards. We identified factors associated with a high risk of in-hospital mortality. Hospitalized CHF subjects with increased risk of in-hospital death present a clinical profile including: very old age, overt cognitive dysfunction, predisposition to falls, dependency, social-family problems, impairment in sphincter control and feeding ability, presence of bedsores, digoxin but not warfarin treatment, hypo-dysproteinemia and hypernatremia and mild renal impairment. We observed that patients admitted to our Internal Medicine Departments, in addition to CHF, present a high grade of complex therapeutic needs and that comorbidity, by itself, does not reflect complexity. Our data support the hypothesis that CHF has different patterns of severity and prognosis in young and in old or very old age groups.