目的 探讨平均动脉压(MAP)对老年心力衰竭患者6个月内再入院和死亡的影响。方法 选取2016-12至2019-06自贡市心力衰竭数据库中1826例患者的临床资料进行回顾性研究。采用PostgreSQL 9.6软件提取MIMIC-Ⅳ数据库中的数据,根据MAP水平分为四组,建立包括粗模型在内的三种不同模型;并对模型进行统计学分析,模型2(按性别和年龄调整)和模式3(针对所有潜在因素进行调整)建立了MAP与6个月再入院与死亡限制性立方样条和平滑曲线拟合,采用 Cox 比例风险回归模型比较不同MAP对6个月再入院和死亡风险的影响。采用限制性立方样条回归模型探讨MAP与6个月再入院和死亡风险之间的反应关系,并通过 log-rank 检验进行比较。结果 本研究共纳入1 826例患者,男743例,女1 083例,MAP与心力衰竭患者的死亡及再入院风险之间存在非线性关系。特别是在老年心力衰竭患者中,MAP水平与6个月内的再入院率和病死率显著相关。在调整多变量因素后,与MAP低于83.33 mmHg的患者相比,MAP处于83.33 mmHg至94 mmHg区间的患者其6个月再入院和病死风险差异无统计学意义;而MAP位于94 mmHg至105.33 mmHg区间的患者,其再入院和死亡风险分别降低了30%和28%;平均较高的MAP水平与6个月再入院和6个月死亡与再入院复合结果的较低风险显著相关。在调整了多变量因素之后,这种关联性依然存在,表明MAP水平可能是老年人群预后的一个重要独立预测因子,当MAP水平低于83.33 mmHg或高于105.33 mmHg时,风险有所增加。结论 MAP与心力衰竭患者6个月死亡和再入院的风险相关,两者呈J型曲线关联。
Abstract
Objective To explore the influence of mean arterial pressure (MAP) on 6-month readmission and mortality in elderly patients with heart failure. Methods A retrospective study was conducted on the clinical data of 1,826 patients from the heart failure database of Zigong city from December 2016 to June 2019. PostgreSQL 9.6 software was used to extract the data from the MIMIC-Ⅳ database. The patients were divided into four groups according to MAP levels, and three different models, including the crude model, were established. Statistical analyses were performed on the models. Model 2 (adjusted for gender and age) and Model 3 (adjusted for all potential factors) were used to establish generalized linear models and generate smoothed fitting curves for MAP in relation to 6-month readmission and mortality. Cox proportional hazards regression models were employed to compare the impact of different MAP levels on 6-month readmission and mortality. Restricted cubic spline regression models were used to explore the response relationship between MAP and 6-month readmission and mortality, and comparisons were made through log-rank tests. Results A total of 1,826 patients were included in this study, including 743 males and 1,083 females. The analysis revealed a non-linear association between MAP and the risks of mortality and readmission in the patients with heart failure. Particularly in elderly patients with heart failure, MAP levels demonstrated a significant correlation with the 6-month readmission and mortality. After multivariable adjustment, no statistically significant differences were observed in the 6-month readmission or mortality between the patients with MAP below 83.33 mmHg and those with MAP in the range of 83.33 to 94 mmHg. However, the patients with MAP values between 94 and 105.33 mmHg exhibited a 30% lower risk of readmission and a 28% lower risk of mortality compared to those with lower MAP levels, respectively. Higher average MAP levels were significantly linked to a lower risk of 6-month readmission, as well as the composite endpoint encompassing the 6-month readmission and mortality. After adjusting for multiple variables, this association persisted, indicating that MAP levels might serve as a significant independent prognostic factor in the elderly population. Specifically, the risks increased when MAP levels were below 83.33 mmHg or above 105.33 mmHg, the risk increased. Conclusions MAP is associated with the risks of 6-month mortality and readmission among patients with heart failure, showing a J-shaped curve relationship.
关键词
平均动脉压 /
心力衰竭 /
再入院 /
全因死亡率 /
队列研究
Key words
mean arterial pressure /
heart failure /
readmission /
all-cause mortality /
cohort study
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