He Zhongkai, Zheng Chongzhou, Chen Menghua, Chen Tao, Huang Fei, Zhu Ziliang, He Yuan, Li Ming
Department of Structural Heart Disease, Cardiovascular Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
Laboratory of Cardiovascular Diseases, Cardiovascular Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
BMC Cardiovasc Disord. 2025 Mar 25;25(1):219. doi: 10.1186/s12872-025-04673-0.
Predicting all-cause readmission in patients with heart failure (HF) is crucial. This study investigated the independent risk factors for short-term readmission and assessed the potential mediators involved in this process.
We evaluated data from 2,254 patients with HF admitted to our institution between January 2019 and December 2020. Logistic regression analysis was used to examine the association between sarcopenia index (SI), neutrophil-to-lymphocyte ratio (NLR), hemoglobin-to-red cell distribution width ratio (HRR), and all-cause 30-d readmission. A restricted cubic spline regression model with three knots assessed potential non-linear relationships between confounders and readmission risk. A mediation analysis was performed to evaluate the direct and indirect effects, as well as the proportion of mediation.
The mean age of the participants was 72 ± 12 years, with 1,324 males (58.7%). The all-cause 30-d readmission rate was 7.1%. HRR was independently associated with 30-d readmission among the evaluated biomarkers, whereas SI and NLR showed no significant correlation. A non-linear relationship was found between HRR and readmission risk, with an inflection point at 0.94. Patients with HRR < 0.94 exhibited a significantly higher risk of readmission, whereas no significant association was found for HRR ≥ 0.94. Mediation analysis revealed that N-terminal pro-B-type natriuretic peptide (NT-proBNP) partially mediated this relationship, which accounted for 13.6% of the effect.
HRR is an independent predictor of all-cause 30-d readmission in patients with a non-linear relationship observed. An inverse association was found for HRR < 0.94, whereas no significant association was found for HRR ≥ 0.94. Additionally, NT-proBNP was identified as a partial mediator of this relationship.
预测心力衰竭（HF）患者的全因再入院至关重要。本研究调查了短期再入院的独立危险因素，并评估了该过程中潜在的中介因素。
我们评估了2019年1月至2020年12月期间入住我院的2254例HF患者的数据。采用逻辑回归分析来检验肌肉减少症指数（SI）、中性粒细胞与淋巴细胞比值（NLR）、血红蛋白与红细胞分布宽度比值（HRR）与全因30天再入院之间的关联。具有三个节点的受限立方样条回归模型评估了混杂因素与再入院风险之间潜在的非线性关系。进行中介分析以评估直接和间接效应以及中介比例。
参与者的平均年龄为72±12岁，其中男性1324例（58.7%）。全因30天再入院率为7.1%。在评估的生物标志物中，HRR与30天再入院独立相关，而SI和NLR无显著相关性。发现HRR与再入院风险之间存在非线性关系，拐点为0.94。HRR<0.94的患者再入院风险显著更高，而HRR≥0.94则未发现显著关联。中介分析显示，N末端B型利钠肽原（NT-proBNP）部分介导了这种关系，占效应的13.6%。
HRR是观察到非线性关系的患者全因30天再入院的独立预测因子。HRR<0.94时呈负相关，而HRR≥0.94时未发现显著关联。此外，NT-proBNP被确定为这种关系中的部分中介因素。
