老年冠心病患者衰弱的影响因素及其风险预测模型构建

Influencing factors of frailty in elderly patients with coronary heart disease and construction of a risk prediction model

中文关键词: 老年  冠心病  衰弱  影响因素  列线图

英文关键词: elderly  coronary heart disease  frailty  influencing factor  nomogram

中文摘要:

      目的 分析老年冠心病患者衰弱的影响因素,构建列线图模型.方法 2021年7月—2024年2月,绵阳四○四医院收治的199例老年冠心病患者分为建模组(n=139)和验证组(n=60).入组后6个月,受试者通过Fried衰弱评估量表评估衰弱情况.二元Logistic回归分析老年冠心病患者衰弱的影响因素,并构建列线图;受试者操作特征(ROC)曲线下面积(AUC)及校准曲线分析模型的预测效能.结果 199例老年冠心病患者,年龄60～86岁,平均(70.8±5.3)岁;其中男性109例,女性90例.建模组78例发生衰弱,验证组30例发生衰弱,衰弱总发生率为54.27％(108/199).二元Logistic回归分析显示,年龄≥70岁、合并症数≥3种、美国纽约心脏病学会(NYHA)分级Ⅲ级、匹兹堡睡眠质量指数(PSQI)＜11分、老年营养风险指数(GNRI)≤98是老年冠心病患者衰弱的危险因素(P＜0.05).ROC曲线显示,建模组AUC 为 0.895(95％CI:0.844～0.947),验证组 AUC 为 0.888(95％CI:0.808～0.967).校准曲线显示,模型的预测概率与实际概率吻合度较高.结论 基于年龄、合并症数、NYHA分级、PSQI和GNRI构建的列线图模型可能对老年冠心病患者衰弱风险的预测效能较佳.

英文摘要:

      Objective To explore the influencing factors of frailty in elderly patients with coronary heart disease,and construct a risk prediction model.Methods From July 2021 to February 2024,199 elderly patients with coronary heart disease admitted to Mianyang 404 Hospital were divided into modeling group(n=139)and validation group(n=60).Six months af-ter enrollment,the frailty of the subjects was evaluated by the Fried Frailty Assessment Scale.Binary Logistic regression was used to analyze the influencing factors of frailty in elderly patients with coronary heart disease,and a nomogram model was con-structed.The area under the curve(AUC)of receiver operating characteristic(ROC)and calibration curve were used to ana-lyze the predictive efficacy of the model.Results The ages of 199 elderly patients with coronary heart disease ranged from 60 to 86 years old,with an average of(70.8±5.3)years old.Among them,there were 109 males and 90 females.Frailty occurred in 78 cases in the modeling group and 30 ones in the validation group.The total incidence of frailty was 54.27％(108/199).Binary Logistic regression analysis showed that age ≥70 years old,number of comorbidities ≥ 3,NYHA classifica-tion Ⅲ,Pittsburgh Sleep Quality Index(PSQI)＜11 points,and Geriatric Nutritional Risk Index(GNRI)≤98 were risk fac-tors for frailty in elderly patients with coronary heart disease(P＜0.05).The ROC curve showed that the AUC of the modeling group was 0.895(95％CI:0.844-0.947),and that of the validation group was 0.888(95％CI:0.808-0.967).Thecalibra-tion curve showed that the predicted probability of the model was highly consistent with the actual probability.Conclusion The nomogram model constructed based on age,the number of comorbidities,NYHA classification,PSQI and GNRI may have bet-ter predictive performance for the frailty risk in elderly patients with coronary heart disease.