血清鸢尾素、新喋呤及甘油三酯葡萄糖指数在慢性心力衰竭合并房颤患者预后评估中的应用价值OA

Objective To investigate the value of serum irisin,neopterin,and triglyceride-glu-cose(TyG)index in assessment of prognosis in patients with chronic heart failure(CHF)complicat-ed with atrial fibrillation.Methods A total of 215 patients with CHF and atrial fibrillation admitted to Xianyang Central Hospital from January 2022 to January 2025 were prospectively enrolled,and 196 were finally included based on inclusion and exclusion criteria.According to the occurrence of end-point events such as readmission for cardiac decompensation or cardiac death within 30 days after discharge,the patients were divided into poor-prognosis group and good-prognosis group.General data of the two groups were collected,and differences in serum irisin,neopterin,and TyG index levels were compared.Multivariate logistic regression analysis was used to identify risk factors for poor prognosis in CHF patients with atrial fibrillation.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of each indicator,the combined serum model(irisin,neopterin,and TyG index),and the comprehensive model(total bilirubin,hemoglobin,irisin,neopterin,and TyG index)for patient prognosis.Results Among 196 patients with CHF and atrial fibrillation,51(26.02％)had a poor prognosis.After Bonferroni correction,the poor-prognosis group had significantly higher total bilirubin levels and lower hemoglobin levels than the good-prognosis group(P＜0.002 38).After Bonferroni correction,compared with the good-progno-sis group,the poor-prognosis group showed significantly lower serum irisin levels and significantly higher serum neopterin levels and TyG index(P＜0.016 7).Multivariate logistic regression analy-sis showed that elevated total bilirubin,neopterin,and TyG index were risk factors for poor progno-sis in CHF patients with atrial fibrillation(P＜0.05),while elevated serum irisin and hemoglobin levels were protective factors(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)(95％CI)of serum irisin,neopterin,and TyG index alone for predicting poor prognosis in CHF patients with atrial fibrillation were 0.760(0.694-0.818),0.791(0.727-0.845),and 0.799(0.736-0.853),respectively;the AUCs of the combined serum model and the comprehen-sive model were 0.896(0.845-0.935)and 0.935(0.891-0.965),respectively.DeLong test results showed that the performance of the combined serum model was superior to that of each indi-vidual indicator,but inferior to that of the comprehensive model(P＜0.05).Conclusion Elevat-ed neopterin and TyG index are risk factors for poor prognosis in CHF patients with atrial fibrillation,while elevated serum irisin is a protective factor.The combined serum model shows good predictive efficacy in this single-center cohort.