Diercks Deborah B, Fonarow Gregg C, Kirk J Douglas, Emerman Charles L, Hollander Judd E, Weber Jim Edward, Summers Richard L, Wynne Janet, Peacock W Franklin
University of California, Davis Medical Center, Sacramento, CA, USA.
Acad Emerg Med. 2008 Feb;15(2):151-8. doi: 10.1111/j.1553-2712.2008.00030.x.
It has been reported that the mortality risk for heart failure differs between men and women. It has been postulated that this is due to differences in comorbid features. Variation in risk profiles by gender may limit the performance of stratification algorithms available for heart failure in women. This analysis examined the ability of a published risk stratification model to predict outcomes in women.
The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) database was used. Characteristics, treatments, and outcomes for men and women were compared. The ADHERE registry classification and regression tree (CART) analysis was used for the risk stratification evaluation.
Of 10,984 ADHERE-EM patients, 5,736 (52.2%) were women. In-hospital mortality was similar between men and women (p = 0.727). Significant differences (p < 0.0002) were noted by gender in all three variables in the CART model (blood urea nitrogen [BUN] > or = 43 mg/dL, systolic blood pressure < 115 mm Hg, and serum creatinine > or = 2.75 mg/dL). However, the CART model effectively stratified both genders into distinct risk groups with no significant difference in mortality by gender within stratified groups.
The ADHERE Registry CART tool is effective at predicting risk in ED patients, regardless of gender.
据报道，心力衰竭的死亡风险在男性和女性之间存在差异。据推测，这是由于合并症特征的差异所致。心力衰竭风险特征的性别差异可能会限制现有的心力衰竭分层算法在女性中的应用效果。本分析检验了一种已发表的风险分层模型预测女性患者预后的能力。
使用急性失代偿性心力衰竭国家注册急诊模块（ADHERE-EM）数据库。比较男性和女性的特征、治疗方法及预后情况。采用ADHERE注册分类与回归树（CART）分析进行风险分层评估。
在10984例ADHERE-EM患者中，5736例（52.2%）为女性。男性和女性的院内死亡率相似（p = 0.727）。在CART模型的所有三个变量（血尿素氮[BUN]≥43 mg/dL、收缩压<115 mmHg和血清肌酐≥2.75 mg/dL）中，按性别分组有显著差异（p < 0.0002）。然而，CART模型有效地将两性患者分层到不同的风险组中，且分层组内按性别分组的死亡率无显著差异。
无论性别如何，ADHERE注册CART工具在预测急诊患者风险方面都是有效的。
