外周灌注指数与乳酸导向的风险预测模型对中老年急性心力衰竭合并低灌注患者预后的预测价值OA

Objective To develop a risk prediction model based on peripheral perfusion index(PI)and blood lactate acid(Lac)levels,aiming to thoroughly evaluate the predictive efficacy of this model for short-term mortality risk in elderly patients with acute heart failure(AHF)complicated by tissue hypoperfusion.Methods A retrospective study was conducted involving 80 middle-aged and elderly patients diagnosed with AHF and accompanied by tissue hypoperfusion,who were admitted to Nanjing Hospital Affiliated to Nanjing Medical University from December 2021 to December 2024.The primary endpoint event was the all-cause mortality rate within 28 days after admission.Patients were divided into survival and death groups based on their final survival status.Baseline clinical characteristics of both groups were collected,including demographic data(gender,age),history of previous underlying diseases,and key biochemical,hemodynamic and echocardiographic indicators within 24 hours of admission,including blood Lac,N-terminal pro-brain natriuretic peptide(NT-proBNP),creatine kinase(CK),MB isoenzyme of creatine kinase(CK-MB),cardiac troponin I(cTnI),central venous pressure(CVP),left ventricular ejection fraction(LVEF),peripheral perfusion index(PI),and acute physiology and chronic health evaluationⅡ(APACHEⅡ).Differences in these parameters between the two groups were compared.Statistically significant variables identified in univariate analysis were included in a binary multivariate Logistic regression analysis,and a column plot prediction tool was subsequently developed.Finally,the discriminatory power,calibration,and clinical net benefit of the model were comprehensively validated using receiver operator characteristic curve(ROC curve),calibration curves,and decision curve analysis(DCA).Results Ultimately,80 patients with AHF accompanied by hypoperfusion who met the criteria were included.A total of 40 deaths occurred within 28 days,with a case fatality rate of 50%.There were no statistically significant differences in gender composition,age distribution,underlying disease spectrum,NT-proBNP,CK,CK-MB,cTnI,CVP,and LVEF between the survival and death groups.The APACHEⅡscore and Lac level in the death group were significantly higher than those in the survival group[APACHEⅡscore:22.53±4.93 vs.16.05±1.91,Lac(mmol/L):2.79±0.55 vs.2.46±0.22,both P<0.05],PI was significantly lower than that in the survival group(0.99±0.22 vs.1.24±0.21,P<0.05).Multivariate Logistic regression analysis showed that low PI[odds ratio(OR)=0.371,95%confidence interval(95%CI)was 0.231-0.496,P=0.001],high Lac(OR=2.022,95%CI was 1.076-4.810,P=0.042),and high APACHEⅡscore(OR=1.724,95%CI was 1.256-2.366,P=0.001)were independent risk factors for poor prognosis in elderly patients with AHF accompanied by hypoperfusion.Based on these 3 independent predictors,a mortality risk prediction equation was constructed:Logit P=-8.677-5.611×PI+0.705×Lac+0.545×APACHEⅡ.Model performance evaluation results showed that area under the curve(AUC)of this prediction model was as high as 0.940(95%CI was 0.900-0.990),indicating good discriminatory ability;the Hosmer-Lemeshow goodness-of-fit test results showed:x2=3.271,P=0.916,indicating good model calibration;DCA also suggests that the model has significant clinical utility across a wide range of threshold probabilities.Conclusions The low PI,high Lac,and high APACHEⅡscores are key independent risk factors determining the prognosis of middle-aged and elderly patients with AHF complicated by hypoperfusion.The risk prediction model constructed by integrating these 3 indicators demonstrates good predictive performance and can provide a strong quantitative basis for early clinical identification of high-risk patients and the development of individualized intervention strategies.