使用 ADHERE 风险模型预测队列中住院心力衰竭恶化的风险。
Use of the ADHERE Risk Model as a Predictor of Risk of in-Hospital Worsening Heart Failure in a Cohort.
机构信息
Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.
Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.
出版信息
Arq Bras Cardiol. 2023 Sep 1;120(8):e20220584. doi: 10.36660/abc.20220584. eCollection 2023.
BACKGROUND
Patients admitted with acute decompensated heart failure (HF) are subject to developing worsening episodes that require more complex interventions. The Acute Decompensated Heart Failure National Registry (ADHERE) risk model was developed in the United States to predict the risk of in-hospital worsening HF.
OBJECTIVE
To use the ADHERE risk model in the assessment of risk of in-hospital worsening HF and to determine its sensitivity and specificity in hospitalized patients.
METHODS
This cohort study was conducted at a Brazilian public university hospital, and data from 2013 to 2020 were retrospectively collected. P values < 0.05 were considered statistically significant.
RESULTS
A total of 890 patients with a mean age of 74 ± 8 years were included. The model showed that, in the group of 490 patients at risk, 254 (51.8%) developed in-hospital worsening HF. In the group of 400 patients not at risk, only 109 (27.2%) experienced worsening HF. The results demonstrated a statistically significant curve (area under the curve = 0.665; standard error = 0.018; P < 0.01; confidence interval = 0.609 to 0.701), indicating good accuracy. The model had a sensitivity of 69.9% and a specificity of 55.2%, with a positive predictive value of 52% and a negative predictive value of 72.7%.
CONCLUSIONS
In this cohort, we showed that the ADHERE risk model was able to discriminate patients who in fact developed worsening HF during the admission period, from those who did not.
背景
因急性失代偿性心力衰竭（HF）入院的患者可能会出现病情恶化，需要更复杂的干预措施。急性失代偿性心力衰竭国家登记处（ADHERE）风险模型是在美国开发的，用于预测住院期间 HF 恶化的风险。
目的
使用 ADHERE 风险模型评估住院期间 HF 恶化的风险，并确定其在住院患者中的敏感性和特异性。
方法
这是一项在巴西一所公立大学医院进行的队列研究，回顾性收集了 2013 年至 2020 年的数据。P 值<0.05 被认为具有统计学意义。
结果
共纳入 890 例平均年龄 74±8 岁的患者。该模型显示，在 490 例有风险的患者中，有 254 例（51.8%）发生了院内 HF 恶化。在 400 例无风险的患者中，只有 109 例（27.2%）发生了 HF 恶化。结果显示曲线具有统计学意义（曲线下面积=0.665；标准误差=0.018；P<0.01；置信区间=0.609 至 0.701），表明准确性良好。该模型的敏感性为 69.9%，特异性为 55.2%，阳性预测值为 52%，阴性预测值为 72.7%。
结论
在本队列中，我们表明 ADHERE 风险模型能够区分实际上在住院期间发生恶化 HF 的患者与未发生恶化 HF 的患者。
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