昆明医科大学学报2026，Vol.47Issue(8)：70-80,11.DOI:10.12259/j.issn.2095-610X.S20260807
基于血清HIF-1 α与CysC构建急性左心衰并发呼吸衰竭患者28 d死亡风险预测模型
Construction of A 28-day Mortality Risk Prediction Model in Patients with Acute Left Heart Failure Complicated by Respiratory Failure Based on Serum HIF-1 α and CysC
摘要
Abstract
Objective To explore the predictive value of serum hypoxia-inducible factor-1alpha(HIF-1 α)and Cystatin C(CysC)levels for 28-day mortality risk in patients with acute left heart failure(AHF)complicated with respiratory failure(RF).Methods A retrospective analysis was conducted on clinical data from 217 AHF patients with concurrent RF admitted between January 2022 and December 2024.Patients were stratified based on 28-day survival status post-discharge into a mortality group(n=62)and a survival group(n=155).General demographic data and serum HIF-1 α and CysC levels were compared between the two groups.The influencing factors for 28-day mortality risk in AHF patients with RF and the relationship between serum HIF-1 α,CysC levels and 28-day mortality risk were analyzed.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of HIF-1 α and CysC for 28-day mortality risk in AHF with RF patients.Risk stratification and clinical validation were performed based on a combined predictive model.Results The mortality group demonstrated significantly higher Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores(16.59±3.05 vs 13.72±2.47,t=7.214,P＜0.001),Sequential Organ Failure Assessment(SOFA)scores(12.61±2.24 vs 11.89±2.15,t=2.202,P=0.029),N-terminal pro-B-type natriuretic peptide(NT-proBNP)(507.41±82.44 vs 329.49±70.55 pg/mL,t=15.975,P＜0.001),HIF-1 α(30.14±4.58 vs 21.37±3.82 ng/L,t=14.410,P＜0.001)and CysC(1.72±0.35 vs 1.30±0.28 mg/L,t=9.270,P＜0.001)compared with the survival group.Logistic regression analysis showed that HIF-1 α(OR=1.315,95％CI:1.129-1.532)and CysC(OR=1.260,95％CI:1.105-1.437)were independent influencing factors for 28 day mortality risk in AHF with RF patients(P＜0.05).Restricted cubic spline(RCS)model analysis demonstrated that after adjusting for other variables,serum HIF-1 α and CysC levels remained linearly and positively correlated with 28 day mortality risk in AHF with RF patients(P＜0.05),with mortality risk progressively increasing as serum HIF-1 α and CysC levels elevated.ROC curve analysis revealed that the area under the curve(AUC)for predicting 28-day mortality risk were as follows:APACHE Ⅱ score 0.737(95％CI:0.673-0.794),SOFA score 0.711(0.646-0.771),NT-proBNP 0.768(0.706-0.822),HIF-1 α 0.748(0.684-0.804),and CysC 0.753(0.690-0.809),with no statistically significant differences in AUC between individual indicators(P＞0.05).Interaction analysis revealed RERI=1.09,AP=0.253,and SI=2.727,indicating a positive additive interaction between HIF-1 α and CysC when both were simultaneously elevated,with the combined effect exceeding the sum of individual effects.The combined predictive AUC for serum HIF-1 α and CysC for 28-day mortality risk in AHF with RF patients was 0.878,significantly higher than the individual AUCs for APACHE Ⅱ score,SOFA score,NT-proBNP,HIF-1 α,and CysC(P＜0.05).Calibration curves demonstrated good concordance between predicted and observed risk across the entire risk spectrum(Hosmer-Lemeshow test,x2=2.224,P=0.086).Internal validation via Bootstrap resampling(1000 iterations)yielded a corrected model AUC of 0.877(95％CI:0.828-0.927),with calibration curves demonstrating good agreement between predicted and actual risk.Decision curve analysis(DC A)indicated clinical net benefit within the threshold probability range of 0.2-0.8,and temporal validation demonstrated high model robustness and predictive performance.Patients stratified into low,intermediate,and high-risk groups based on the combined predictive model had actual 28-day mortality rates of 4.17％,27.40％,and 54.17％,respectively(P＜0.05).Conclusion Serum HIF-1 α and CysC levels in AHF patients with concurrent RF are closely associated with 28-day mortality risk.A combined predictive model constructed from these two markers demonstrates excellent discriminative ability.关键词
急性左心衰/呼吸衰竭/28 d死亡风险/缺氧诱导因子-1α/胱抑素CKey words
Acute left heart failure/Respiratory failure/28-day mortality risk/Hypoxia-inducible factor-1 α/Cystatin C分类
医药卫生引用本文复制引用
莫世芳,薛雅馨,宋嘉,陈安琪,王琳..基于血清HIF-1 α与CysC构建急性左心衰并发呼吸衰竭患者28 d死亡风险预测模型[J].昆明医科大学学报,2026,47(8):70-80,11.基金项目
湖南省自然科学基金(2024JJ7658) （2024JJ7658）
