血清总钙水平作为心力衰竭患者住院死亡率的非线性预测因子：来自回顾性队列研究的见解。

Serum total calcium levels as a non-linear predictor of in-hospital mortality in heart failure patients: insights from a retrospective cohort study.

机构信息

Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.

出版信息

BMC Cardiovasc Disord. 2024 Nov 25;24(1):672. doi: 10.1186/s12872-024-04348-2.

DOI:10.1186/s12872-024-04348-2

PMID:39587490

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11590463/

Abstract

BACKGROUND

Calcium is pivotal in the regulation of bodily homeostasis, with numerous studies highlighting its link to cardiovascular disease in the adult population. However, the relationship between serum calcium levels and the prognosis of heart failure (HF) patients is not clear. This study explored the association between serum total calcium (STC) and in-hospital mortality in patients with HF.

METHODS

Clinical data of 1,176 patients with HF were obtained from the Multiparametric Intelligent Monitoring in Intensive Care III (MIMIC-III) database. The patients were categorized into STC quartiles, and baseline characteristics were comprehensively analyzed. Univariate and multivariate analyses were employed to identify factors associated with in-hospital mortality. To explore the non-linear relationship between STC and mortality, a two-piecewise linear regression model was applied. Subgroup analyses were conducted to identify potential confounding variables.

RESULTS

In this cohort, 159 (13.53%) patients experienced in-hospital mortality. Significant differences in various parameters were observed among STC quartiles. Univariate analysis identified numerous factors associated with mortality. Multivariate analysis confirmed STC as an independent predictor of in-hospital mortality, with a negative association persisting even after adjusting for confounding factors (odds ratio [OR]: 0.49, 95%CI: 0.32-0.76; P = 0.0016). Non-linear analysis revealed an inflection point at 8.41 mg/dL, below which the risk of in-hospital death significantly increased (OR: 0.26, 95%CI: 0.12-0.55; P = 0.0005). Subgroup analyses indicated a pronounced inverse association in patients without atrial fibrillation or chronic obstructive pulmonary disease, as well as those with a left ventricular ejection fraction ≤ 50%.

CONCLUSION

This study identified STC as an independent predictor of in-hospital mortality in HF patients, with a non-linear relationship.

摘要

背景

钙在调节体内稳态方面起着关键作用，许多研究强调了其与成年人群心血管疾病的关联。然而，血清钙水平与心力衰竭（HF）患者预后之间的关系尚不清楚。本研究探讨了血清总钙（STC）与 HF 患者住院期间死亡率之间的关系。

方法

从 Multiparametric Intelligent Monitoring in Intensive Care III（MIMIC-III）数据库中获取了 1176 例 HF 患者的临床数据。将患者分为 STC 四分位组，全面分析了基线特征。采用单变量和多变量分析来确定与住院期间死亡率相关的因素。为了探讨 STC 与死亡率之间的非线性关系，应用了两段线性回归模型。进行了亚组分析以确定潜在的混杂变量。

结果

在该队列中，有 159 例（13.53%）患者发生住院期间死亡。STC 四分位组之间观察到各种参数存在显著差异。单变量分析确定了许多与死亡率相关的因素。多变量分析证实 STC 是住院期间死亡率的独立预测因子，即使在调整了混杂因素后，这种负相关仍然存在（优势比 [OR]：0.49，95%置信区间：0.32-0.76；P=0.0016）。非线性分析显示在 8.41mg/dL 处存在拐点，在此之下，住院死亡的风险显著增加（OR：0.26，95%置信区间：0.12-0.55；P=0.0005）。亚组分析表明，在没有心房颤动或慢性阻塞性肺疾病的患者以及左心室射血分数≤50%的患者中，存在明显的负相关关系。