Study On The Relationship Between EGFR And Frailty In The Patients With Chronic Heart Failure

Objective:To study the relationship between estimated glomerular filtration rate(eGFR)and frailty in hospitalized patients with chronic heart failure(CHF),and to explore the correlation between eGFR levels and various dimensional indicators,and to clarify its influence and effect on frailty,which is CHF Provide basis for early prevention and effective intervention of frail patients.Methods:This experiment selected 321 CHF patients who were admitted to the Second Hospital of Jilin University from December 2019 to December 2020.Collect clinical data and biochemical indicators of patients,including gender,age,Body Mass Index(BMI),education level,marriage,occupation type,smoking history,drinking history,NT-pro BNP,cardiac function,left ventricular ejection fraction(LVEF),total protein,urea nitrogen,serum creatinine(Scr),eGFR,fasting blood glucose,total cholesterol(TC),triglycerides(TG),low density fat Protein cholesterol(LDL-C),length of illness,oral medication,history of hypertension and diabetes.The Tilburg scale was used to assess the frailty status of the selected patients,and they were divided into two groups according to the score results:the non-frailty group(control group),with a total of 164 cases;the frailty group(experimental group),with a total of 157 cases.Compare the differences in clinical data and biochemical indicators between the two groups.According to eGFR levels,CHF patients were divided into four groups:Group A:eGFR<30ml/(min/1.73m2)),Group B:eGFR:(30-59)ml/(min/1.73m2),Group C:eGFR:(60-89)ml/(min/1.73m2),group D:eGFR≥90ml/(min/1.73m2),further analyze the weakness between the 4 groups and the differences in indicators of each dimension.Spss25.0 statistical software was used for analysis.Measurement data:those that conform to the normal distribution are represented by((?)±s),and the comparison between groups is by t test;those that are not conformed to the normal distribution are represented by M(P25,P75),and the Wilconxon rank sum test is used for comparison between groups.Enumeration data:expressed in percentage(%),and comparison between groups was performed using X~2 test and Kruskal-Wallis H test.P<0.05 indicates that the difference is statistically significant.Spearman’s bivariate correlation analysis was used to compare the correlation between eGFR and CHF frailty and the scores of various dimensions.Logistic multivariate regression was used to analyze the independent influencing factors of frailty.P<0.05 indicates that the difference is statistically significant.The ROC curve is used to analyze the predictive value of eGFR for frailty diagnosis,to find the best cut-off value,and to predict its influence and effect on CHF frailty.Results:1.The frailty status of CHF patientsIn the 321 CHF patients in this experiment,the highest TFI score was 11.5 points,the lowest score was 0 points,and the median was 4 points.The median scores for physical,psychological,and social dimensions were 2 points,1.5 points,and 1 point,respectively.According to the Tilburg scale score,they were divided into frailty group(>4 points)and non-frailty group(≤4 points).Among them,there were 157 cases in the frailty group and 164cases in the non-frailty group.The incidence of frailty CHF patients was about 48.9%.2.Comparison of general data of CHF patients with frailty group and non-frailty groupCompared with the non-frailty group,the frailty group had statistically significant differences in gender,age,marriage,BMI,hypertension,heart function,sleep quality,NT-pro BNP,urea nitrogen,Scr and eGFR(P<0.05).There were no statistically significant differences in occupation,education level,smoking history,drinking history,course of disease,LVEF,oral ACEI/ARB drug history,total protein,blood sugar,TG,TC,LDL-C and diabetes(P>0.05).3.Comparison of general data of 4 eGFR groups in CHF patientsThere were statistically significant differences in age,hypertension,NT-pro BNP,urea nitrogen,Scr,and eGFR among the four subgroups(P<0.05).Gender,BMI,occupation,marriage,education,smoking history,drinking history,course of disease,LVEF,diabetes,total protein,blood sugar,TG,TC,LDL-C and ACEI/ARB drug taking history had no difference among the 4 subgroups Statistical significance(P>0.05).4.The role of eGFR levels in the frailty of CHF patients4.1 The relationship between eGFR levels and the frailty of CHF patientsThe linear correlation analysis between eGFR and TFI scale scores showed that the frailty score was negatively correlated with eGFR levels(r=-0.551,P<0.05).4.2 Frailty between different eGFR groupsThe number of debilitated persons in group A,group B,group C,and group D were 62(68.9%),49(49.5%),37(43.5%),and 9(19.1%),respectively.Comparing the two groups,it was found that there were statistically significant differences in frailty between groups A and B,A and C,A and D,B and D,and C and D(P<0.05).There was no statistically significant difference between group B and C(P>0.05).4.3 The effect of eGFR level on the frailty of CHF patientsMultivariate regression analysis was performed with the occurrence of frailty as the dependent variable,and the results after controlling for confounding factors:eGFR is an independent factor influencing the incidence of frailty in CHF patients.For every unit increase in eGFR level,the risk of frailty disease increased by 0.981 times(OR=0.981,95%CI=0.973,0.999)P<0.05).The risk of frailty in group A and group B is 16.662 times and 2.675 times that of group D,respectively.There was no statistically significant difference between group C and group D(P>0.05).4.4 The predictive value of eGFR levels for the frailty and prevalence of CHF patientsTaking frailty as the state variable and eGFR as the test variable,ROC curve analysis was performed to analyze the predictive value of eGFR for the occurrence of frailty in CHF patients.The area under the ROC curve is 0.668,P<0.05,95%CI(0.609-0.727),indicating that eGFR has predictive value for the occurrence of frailty.When eGFR≤42.95ml/min/1.73m2,the sensitivity of predicting frailty is 0.535,specificity It is 0.756,and the maximum value of the Youden Index is 0.291.5.Correlation between eGFR levels and various dimensions of CHF patients’frailty5.1 Analysis of the relationship between eGFR levels and physical frailty1)Spearman correlation analysis between eGFR level and physical frailty score showed that eGFR level and physical frailty were negatively correlated(r=0.448,P<0.05),the difference was statistically significant.2)The median scores of physical frailty among A,B,C,and D are 3 points,2 points,2points,and 1 point.Pairwise comparisons between groups showed that there were statistically significant differences in the physical frailty scores between groups A and B,A and C,A and D,B and C,and B and D(P<0.05).There was no statistically significant difference in physical frailty scores between groups C and D(P>0.05).5.2 Analysis of the relationship between eGFR levels and mental frailty1)Spearman correlation analysis between eGFR level and mental frailty score shows that the two are negatively correlated(r=-0.47,P<0.05).2)Mental frailty scores 2 points,1.5 points,1 point,and 0 points in the 4 groups A,B,C,and D respectively.The pairwise comparisons between groups showed that there were statistically significant differences in mental frailty scores between groups A and B,groups A and C,groups A and D,groups B and D,and groups C and D(P<0.05).There was no statistically significant difference in mental frailty scores between groups B and C(P>0.05).5.3 Analysis of the relationship between eGFR levels and social frailty1)Spearman correlation analysis showed that eGFR level and social frailty score were negatively correlated(r=-0.441,P<0.05).2)The social frailty scores between groups A,B,C,and D are 1 point,1 point,0.5 point,and 0 point respectively.We can see that the differences in social frailty scores between groups A and B,A and C,A and D,B and C,and B and D are statistically significant(P<0.05).There was no statistically significant difference in social frailty scores between groups C and D(P>0.05).Conclusion:1.eGFR is an independent factor influencing the occurrence of frailty in CHF patients,and can predict the occurrence of frailty;and the lower the eGFR level,the higher the frailty score.2.The lower the eGFR level,the higher the risk of physical frailty,mental frailty and social frailty.