实用医学杂志2025，Vol.41Issue(5)：691-698,8.DOI:10.3969/j.issn.1006-5725.2025.05.011
基于GNRI评分构建慢性心力衰竭患者营养不良风险的列线图模型
Nomogram model of malnutrition risk in patients suffering from chronic heart failure grounded on GNRI score
摘要
Abstract
Objective We investigated the clinical features and the potential risk factors of malnutrition in patients with chronic heart failure(CHF),and constructed the risk prediction model of malnutrition.Methods A total of459 CHF patients admitted between January 2023 and July 2024 were classified into a normal nutrition group and a malnutrition group based on the geriatric Nutrition Risk Index(GNRI)score upon admission.The patient-related data were gathered,and single-variable and multi-variable logistic analyses were first carried out to identify the risk factors associated with the malnutrition risk.Subsequently,the stepwise regression approach was employed to define the inclusion criteria and construct a malnutrition nomogram model for CHF patients.The diagnostic efficacy and calibration of this model were appraised using the ROC curve and calibration curve,and its clinical utility was assessed via the clinical decision curve.A P value less than 0.05 signified statistically significant differences.Results Anxiety(OR=1.1902,95%CI:1.0217～1.3865),urea nitrogen(OR=1.4842,95%CI:1.1187～1.9691),low body weight(OR=0.8463,95%CI:0.7852～0.9121),and low albumin(OR=0.0467,95%CI:0.0172～0.1268)were risk factors for malnutrition.The optimal model inclusion factors were selected by stepwise regression,including:Body weight,7 items of Generalized Anxiety Disorder Scale(GAD-7),urea nitrogen,uric acid,albumin,total cholesterol,high density lipoprotein cholesterol(HDL-L),low density lipoprotein cholesterol(LDL-L),D-dimer.The area under the ROC curve(AUC)of the column chart model based on the above factors is 0.996(95%CI:0.971～0.978),with a sensitivity of 97.8%and a specificity of 97.1%.The C-index validated internally in the calibration curve was 0.824.The calibration chart and validation results demonstrate good consis-tency and applicability.Conclusion The column chart prediction model created in this study based on nine factors including body weight,GAD-7,urea nitrogen,uric acid,albumin,total cholesterol,HDL-L,LDL-L,and D-dimer had good calibration and prediction performance,and had good clinical practicality,which was helpful for clinicians to make diagnosis and treatment decisions for malnutrition in CHF patients.关键词
慢性心力衰竭/营养不良/危险因素/焦虑/列线图模型Key words
chronic heart failure/malnutrition/risk factors/anxiety/nomogram model分类
医药卫生引用本文复制引用
莫乔莹,朱芳一,祝存奎,马生龙..基于GNRI评分构建慢性心力衰竭患者营养不良风险的列线图模型[J].实用医学杂志,2025,41(5):691-698,8.基金项目
青海省卫生健康系统指导性计划课题(编号:2023-wjzdx-51) （编号:2023-wjzdx-51）
