Muñoz Miguel Angel, Calero Esther, Duran Julio, Navas Elena, Alonso Susana, Argemí Nuria, Casademunt Marta, Furió Patricia, Casajuana Elena, Torralba Nuria, Farre Nuria, Abellana Rosa, Verdú-Rotellar José-Maria
Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain.
Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain.
J Clin Med. 2022 Apr 19;11(9):2280. doi: 10.3390/jcm11092280.
Background: Information regarding short-term vital prognosis in patients with heart failure at advanced stages of the disease is scarce. Objective: To develop a three-month mortality predictive model for patients with advanced heart failure. Methods: Prospective observational study carried out in primary care and a convalescence community facility. Heart failure patients either New York Heart Association (NYHA) III with at least two HF hospitalizations during the previous six months or NYHA IV with/without previous recent hospitalization were included in the study. Multivariable predictive models using Cox regression were performed. Results: Of 271 patients included, 55 (20.3%) died during the first three months of follow-up. Mean age was 84.2 years (SD 8.3) and 59.8% were women. Predictive model including NT-proBNP had a C-index of 0.78 (95% CI 0.71; 0.85) and identified male gender, low body mass index, high potassium and NT-proBNP levels, and moderate-to-severe dependence for daily living activities (Barthel index < 40) as risk factors of mortality. In the model without NT-proBNP, C index was 0.72 (95% CI 0.64; 0.79) and, in addition to gender, body mass index, low Barthel index, and severe reductions in glomerular filtration rate showed the highest predictive hazard ratios for short-term mortality. Conclusions: In addition to age, male gender, potassium levels, low body mass index, and low glomerular filtration, dependence for activities of daily living add strong power to predict mortality at three months in patients with advanced heart failure.
关于疾病晚期心力衰竭患者短期生命预后的信息匮乏。目的：为晚期心力衰竭患者建立一个三个月死亡率预测模型。方法：在初级保健机构和康复社区设施中进行前瞻性观察研究。研究纳入了纽约心脏协会（NYHA）III级且在过去六个月内至少有两次心力衰竭住院治疗的患者，或NYHA IV级且有/无近期住院治疗史的心力衰竭患者。使用Cox回归进行多变量预测模型分析。结果：纳入的271例患者中，55例（20.3%）在随访的前三个月内死亡。平均年龄为84.2岁（标准差8.3），女性占59.8%。包含NT-proBNP的预测模型的C指数为0.78（95%置信区间0.71；0.85），并将男性、低体重指数、高钾和NT-proBNP水平以及中度至重度日常生活依赖（Barthel指数<40）确定为死亡风险因素。在不包含NT-proBNP的模型中，C指数为0.72（95%置信区间0.64；0.79），除性别、体重指数、低Barthel指数外，肾小球滤过率严重降低对短期死亡率显示出最高的预测风险比。结论：除年龄、男性、血钾水平、低体重指数和低肾小球滤过率外，日常生活依赖对晚期心力衰竭患者三个月死亡率的预测具有很强的作用。
