Correlation Between PLR,CAR,HRR And Frailty In Elderly Patients With Coronary Heart Disease

Background :The definition of coronary heart disease(CHD)is coronary atherosclerotic heart disease.Coronary heart disease is a common cardiovascular system disease in the elderly people which is one of the main causes of poor quality of life and poor prognosis outcomes in the elderly.Frailty is a clinical syndrome characterized by reduced physiological reserves and function in multiple systems,and increased vulnerability to stressors.In the process of population aging,frailty often interacts and coexists with cardiovascular diseases,especially coronary heart disease.A large number of research results show that frailty is an independent risk factor for poor prognosis in patients with coronary heart disease.Patients with coronary heart disease combined with frailty have higher readmission rates,mortality,and major adverse cardiovascular events(MACE),and lower survival rates.Therefore,it is very important to accurately and timely identify the frailty state and give the correct intervention measures for the health management of elderly patients with coronary heart disease.Frailty is currently assessed through different scale tools,studies have shown that the incorporating of biomarkers into traditional frailty assessment scales can improve the ability to predict frailty,and also some researchers have proposed that the combination of multi-dimension and multi-index may have higher value in predicting frailty than a single index.Although the common mechanism of frailty and coronary heart disease are not fully defined,current studies have found that chronic inflammation,immune changes,nutrition and other mechanisms play an important role in the common development of coronary heart disease and frailty.Platelet to Lymphocyte ratio(PLR)、C-reactive protein to Albumin ratio(CAR)、Hemoglobin to Red cell Distribution Width ratio(HRR)is a composite index of markers that combine immune and nutritional factors on the foundation of inflammation.It is able to comprehensive reflect the changes in inflammatory,immune and nutritional status.Moreover,it has been proven to play a stronger role than a single inflammatory biomarker in the diagnosis and prognosis of cardiovascular diseases,malignant tumors,inflammatory diseases,wasting diseases and other diseases.Studies also confirmed that PLR,CAR and HRR play an important role in frailty.Therefore,we speculate that PLR,CAR and HRR may play an crucial role in coronary heart disease combined with frailty through inflammatory,immune and nutritional mechanisms.Objective :This study analyzed the correlation between PLR,CAR,HRR and frailty in elderly patients with coronary heart disease,to further explore the predictive value of PLR,CAR and HRR for the occurrence of frailty in elderly patients with coronary heart disease.To provide scientific basis for timely and accurate assessment of the elderly patients with coronary heart disease combined with frailty.Furthermore,complete the health management of the elderly patients with coronary heart disease combined with frailty,reduce the occurrence of poor prognosis,and improve the quality of life.Methods :Select the sample of the Hospital of Jilin University from December 2021 to January 2023,total of 344 patients with coronary heart disease aged 60 years or older who were hospitalized in the Department of Cardiovascular Medicine.Collect clinical data and laboratory findings of enrolled patients who were selected,then calculate PLR,CAR and HRR(Calculation method: PLR= Platelet count/Lymphocyte count;CAR=C-Reactive protein/Albumin;HRR= Hemoglobin/Red cell Distribution Width).According to the Chinese version of the Edmonton frailty Scale(EFS)to evaluate the enroll patients.According to the result of EFS,elderly patients with coronary heart disease were divided into non-frailty group(0≤EFS < 8)and frailty group(8≤EFS≤17).Compare the level difference between the two groups of PLR,CAR、HRR and the difference of general clinical data and test indexes of PLR,CAR、HRR.Use ±S to describe the measurement information that conform to or approximate to the normal distribution in the indicators,Use t test to compare the differences between the two groups.The measurement information of skewness distribution were described by the median M(P25,P75),and the rank sum test was used to analyze the difference.Enumeration information use n(%)to described,and variance analysis with the X~2 tests.The indexes with statistically significant differences in the above data were incorporated into the binary multivariate logistic regression analysis to analyze the influencing factors of frailty occurrence in elderly patients with coronary heart disease.Then,put the frailty group the into three subgroups which are mild frailty group(8≤EFS≤9),moderate frailty group(10≤EFS≤11),and severe frailty group(12≤EFS≤17).Compare the levels of PLR,CAR、HRR,and the general clinical data and test indexes of PLR,CAR、HRR between the non-frailty group and the frailty degree group.Use variance analysis to compare the difference of measurement information of multiple groups of normal distribution,use LSD test to compare differences between pairwise groups,and use Kruskal-Wallis H to compare the measurement information of multiple groups with skewed distribution.The indexes with statistically significant differences in the data were incorporated into ordered multiple logistic regression analysis to analyze the factors influencing the degree of frailty in elderly patients with coronary heart disease.In addition,use the spearman correlation coefficient to analyze the correlation between PLR,CAR and HRR and EFS scores.At last,use ROC curve to analyze the predictive value of PLR,CAR and HRR alone or in combination in frailty in elderly patients with coronary heart disease.P < 0.05 was considered to be statistically significant in the above studies.Results:1.The situation of frailty in elderly patients with coronary heart diseaseA total of 344 elderly patients with coronary heart disease were included in this study,104 people were in the frailty group(EFS≥8),and the frailty incidence was30.23%,include 52 were in the mild frailty group(8≤EFS≤9),34 were in the moderate frailty group(10≤EFS≤11),and 18 were in the severe frailty group(12≤EFS≤17),with the incidence of 15.12%,9.88% and 5.23%,respectively.2.Correlation between PLR,CAR,HRR and the incidence of frailty in elderly patients with coronary heart diseaseIn elderly patients with coronary heart disease,the frailty group had higher PLR(173.37 vs 136.37,P<0.001),higher CAR(0.121 vs 0.041,P<0.001)and lower HRR(9.46 vs 11.01,P < 0.001)than the non-frailty group.In binary multivariate logistic regression analysis,PLR,CAR and HRR were independent factors of frailty after adjusting for confounding factors such as gender,age,LVEF,e GFR,TBIL and NT-pro BNP.PLR(OR=1.007,95%CI=1.002～1.011,P=0.002)and CAR(OR=12.585,95%CI=1.129～140.252,P=0.040)were positively correlated with frailty.HRR(OR=0.636,95%CI=0.519 ～ 0.779,P < 0.001)was negatively correlated with frailty.3.Correlation study of PLR,CAR,HRR and frailty degree in elderly patients with coronary heart diseaseGroups with different degrees of frailty were selected as dependent variables,and indexes with statistical differences among subgroups of PLR,CAR,HRR and frailty(gender,age,LVEF,BUN,e GFR,LDL-C,TBIL,NT-pro BNP)were selected as independent variables for ordered multivariate logistic regression analysis,and the result shows that after adjusting for confounding factors,PLR and CAR were positively correlated with frailty,with OR values of 1.009(95%CI=1.005～1.013,P<0.001)and 19.849(95%CI=2.091～188.434,P=0.009),respectively.HRR was negatively correlated with frailty(OR=0.636,95%CI=0.523～0.774,P<0.001).Spearman correlation analysis was conducted between PLR,CAR,HRR and Edmonton frailty scale scores respectively,the results showed that PLR level was positively correlated with Edmonton frailty scale score(r=0.244,P<0.001),and the correlation intensity was weak.CAR level was positively correlated with Edmonton frailty Scale score(r=0.261,P<0.001),and the correlation intensity was weak.The level of HRR was negatively correlated with EFS score(r=-0.349,P < 0.001),and the correlation intensity was moderate,and the differences were statistically significant.4.Diagnosis value of PLR,CAR and HRR alone and combined in the incidence of frailty in elderly patients with coronary heart diseaseThe ROC curves of PLR,CAR and HRR alone and in combination were plotted for the risk of frailty in elderly patients with coronary heart disease separately.The results showed that the AUC of PLR was 0.635(95%CI=0.567～0.704,P<0.001),and the optimal cut-off value was 219.50.The sensitivity and specificity of PLR in diagnosis the occurrence of frailty in elderly patients with coronary heart disease were0.365 and 0.887,respectively.The AUC of CAR was 0.682(95%CI=0.622 ～0.742,P<0.001),and the optimal cut-off value was 0.094.The sensitivity and specificity for diagnosis frailty in elderly patients with coronary heart disease were0.615 and 0.671 respectively.The AUC of HRR was 0.749(95%CI=0.692～0.807,P < 0.001),and the optimal cut-off value was 9.73.The sensitivity and specificity of diagnosis the occurrence of frailty in elderly patients with coronary heart disease were0.615 and 0.813,respectively.The maximum AUC value of PLR,CAR and HRR was0.801(95%CI=0.751 ～ 0.852,P < 0.001),and the corresponding sensitivity and specificity were 0.875 and 0.617,respectively.Conclusion :1.PLR,CAR and HRR are correlated with the occurrence of frailty in elderly patients with coronary heart disease,and they are all independent correlation factors for the occurrence of frailty in elderly patients with coronary heart disease.PLR and CAR are positively correlation for frailty in elderly patients with coronary heart disease,and HRR is negatively correlation for frailty.2.PLR,CAR and HRR were correlated with the degree of frailty in elderly patients with coronary heart disease.PLR and CAR are positively correlation for frailty degree in elderly patients with coronary heart disease,and HRR is negatively correlation for frailty degree in elderly patients with coronary heart disease.3.PLR,CAR and HRR all have a certain diagnosis value for the occurrence of frailty in elderly patients with coronary heart disease,The diagnosis value of the combined application is higher than the single application.