Huang Tao, Huang Xingjie, Cui Xueying, Dong Qinghua
Department of Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region 541100, P.R. China.
Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region 541100, P.R. China.
Exp Ther Med. 2024 Feb 28;27(4):171. doi: 10.3892/etm.2024.12459. eCollection 2024 Apr.
The aim of the present study was to identify the independent risk factors and prognostic indicators for atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) and to develop predictive nomogram models. This retrospective study included a total of 286 patients with COPD who were admitted to the Second Affiliated Hospital of Guilin Medical College between January 2020 and May 2022. The average age of the patients was 77.11±8.67 years. Based on the presence or absence of AF, the patients were divided into two groups: The AF group (n=87) and the non-AF group (n=199). Logistic regression analysis was conducted to identify variables with significant differences between the two groups. Nomogram models were constructed to predict the occurrence of AF in COPD patients and to assess prognosis. Survival analysis was performed using the Kaplan-Meier method. The follow-up period for the present study extended until April 31, 2023. Survival time was defined as the duration from the date of the interview to the date the participant succumbed or the end of the follow-up period. In the present study, age, uric acid (UA) and left atrial diameter (LAD) were found to be independent risk factors for the development of AF in patients diagnosed with COPD. The stepwise logistic regression analysis revealed that age had an odds ratio (OR) of 1.072 [95% confidence interval (CI): 1.019-1.128; P=0.007], UA had an OR of 1.004 (95% CI: 1.001-1.008; P=0.010) and LAD had an OR of 1.195 (95% CI: 1.098-1.301; P<0.001). Univariate and multivariate Cox regression analysis revealed that LAD and UA were independent prognostic factors for long-term mortality in COPD patients with AF. LAD had a hazard ratio (HR) of 1.104 (95% CI: 1.046-1.165; P<0.001) and UA had an HR of 1.004 (95% CI: 1.000-1.008; P=0.042). Based on these findings, predictive nomogram models were developed for AF in COPD patients, which demonstrated good discrimination ability with an area under the curve of 0.886. The prognostic nomogram for COPD patients with AF also showed good predictive accuracy with a concordance index of 0.886 (95% CI: 0.842-0.930). These models can provide valuable information for risk assessment and prognosis evaluation in clinical practice. Age, UA and LAD are independent risk factors for AF in COPD patients. The developed nomogram models provide a reliable tool for predicting AF in COPD patients and for prognosis assessment.
本研究的目的是确定慢性阻塞性肺疾病（COPD）患者发生心房颤动（AF）的独立危险因素和预后指标，并建立预测列线图模型。这项回顾性研究共纳入了2020年1月至2022年5月期间在桂林医学院第二附属医院住院的286例COPD患者。患者的平均年龄为77.11±8.67岁。根据是否存在AF，将患者分为两组：AF组（n = 87）和非AF组（n = 199）。进行逻辑回归分析以确定两组之间存在显著差异的变量。构建列线图模型以预测COPD患者AF的发生并评估预后。采用Kaplan-Meier法进行生存分析。本研究的随访期延长至2023年4月31日。生存时间定义为从访谈日期到参与者死亡日期或随访期结束的持续时间。在本研究中，年龄、尿酸（UA）和左心房直径（LAD）被发现是诊断为COPD患者发生AF的独立危险因素。逐步逻辑回归分析显示，年龄的比值比（OR）为1.072 [95%置信区间（CI）：1.019 - 1.128；P = 0.007]，UA的OR为1.004（95% CI：1.001 - 1.008；P = 0.010），LAD的OR为1.195（95% CI：1.098 - 1.301；P < 0.001）。单因素和多因素Cox回归分析显示，LAD和UA是COPD合并AF患者长期死亡率的独立预后因素。LAD的风险比（HR）为1.104（95% CI：1.046 - 1.165；P < 0.001），UA的HR为1.004（95% CI：1.000 - 1.008；P = 0.042）。基于这些发现，为COPD患者开发了AF预测列线图模型，其曲线下面积为0.886，显示出良好的区分能力。COPD合并AF患者的预后列线图也显示出良好的预测准确性，一致性指数为0.886（95% CI：0.842 - 0.930）。这些模型可为临床实践中的风险评估和预后评估提供有价值的信息。年龄、UA和LAD是COPD患者发生AF的独立危险因素。所开发的列线图模型为预测COPD患者的AF和评估预后提供了可靠的工具。
