| Background and Objective:Frailty is a common clinical syndrome in the elderly characterized by increased vulnerability to stress and reduced physiological reserve.Chronic heart failure（CHF）is the end stage of heart disease,which is characterized by high mortality and is prone to frailty.Frailty can lead to the deterioration of the condition of patients with chronic heart failure and seriously affect the prognosis of patients.At present,the most common methods for identifying frailty in CHF patients are in the form of scales.Although it is economical to use scales to identify frailty,it is cumbersome in heavy clinical work;Some patients or family members may not cooperate in the evaluation of the scale;moreover,there is a certain degree of subjectivity in the use of the scale,which limits its application in the identification of frailty in CHF patients.Therefore,there is a need for a more convenient and accurate method for early identification of frailty in CHF patients.Studies have shown that inflammatory factors,fibrosis and apoptosis play an important role in the development of frailty and CHF.s ST2（Soluble Suppression of Tumorigenicity 2 protein,）is a member of the interleukin-1 receptor family,which plays an important role in chronic inflammation and myocardial remodeling.s ST2 may play an important role in the occurrence and development of frailty in CHF patients,and may have important significance in the early identification of frailty in CHF patients.In this experiment,by studying the correlation between s ST2 level and frailty in hospitalized CHF patients,we can clarify its influence on frailty in CHF patients,and then explore the potential of s ST2 as a biomarker of frailty in CHF patients,and provide a basis for the early identification of frailty in CHF patients.It is of great significance for improving the prognosis of patients with CHF.Methods:A total of 115 CHF patients admitted to the Department of Cardiovascular Medicine of the Second Hospital of Jilin University from December 2020 to December 2021 were selected.The blood samples of the selected patients were collected in the morning after admission,and serum s ST2 levels were determined by enzyme linked immunosorbent assay（ELISA）.The general clinical data and biochemical indicators of the selected patients were collected.The Clinical Frailty Scale（CFS）was used to score the frailty and assess the frailty of the CHF patients included in the study,and they were divided into a non-frailty group（control group）and a frailty group（experimental group）.The non-frail group was divided into two subgroups: healthy group（A group）and vulnerable group（B group）,and the frail group was divided into two subgroups: mild frailty group（C group）and moderate to severe frailty group（D group）.This experiment is divided into four steps.The first step is to analyze the prevalence of frailty in CHF patients.In the second step,the general clinical data and biochemical indicators of the frail group and the non-frail group were analyzed;in the third step,the effect of serum s ST2 level on the frailty of CHF patients was analyzed.First,compare whether there is a difference in serum s ST2 levels between the non-frail group and the frail group;second,in order to control the interference of confounding factors,the indicators with statistical differences in the second step were included in the regression model for multivariate logistic regression analysis;After multivariate analysis,the indicators that still had statistical significance were analyzed with serum s ST2 levels alone to analyze whether there was an influence between the two;after that,the serum s ST2 levels of patients in the healthy group,vulnerable group,mildly weak group,and moderately severe weakness group were analyzed.Levels are compared pairwise.Finally,the correlation analysis between serum s ST2 level and CFS score was performed.In the fourth step,the diagnostic value of s ST2 for frailty in CHF patients was assessed using ROC curve analysis.Results:1.Frailty in CHF patientsThe CHF patients were divided into a non-frail group（CFS≤4,a total of 53 cases）and a frail group（CFS≥5,a total of 62 cases）.The prevalence of frailty in CHF patients was 53.9%,and the non-frail group was divided into healthy group（CFS≤3）and vulnerable group（CFS=4）,the frail group was divided into mild frailty group（CFS=5）and moderate to severe frailty group（CFS≥6）,a total of 26 cases in the healthy group and a total of 26 cases in the vulnerable group 27 cases,30 cases in mild weakness group and 32 cases in moderate to severe weakness group.2.Comparison of general clinical data and biochemical indexes between frail group and non-frail group of CHF patientsThe results showed that compared with the non-frail group,the patients in the frail group had higher age（69 years old> 63 years old,P=0.008）,poorer cardiac function（P=0.016）,and higher NT-pro BNP（5403.07ng/m L> 2613.80ng/m L,P=0.001）,higher HSP（3.02 mg/L>1.87 mg/L,P=0.009）,lower glomerular filtration rate（66.65 m L/min<79.3m L/ min,P=0.001）,higher white blood cell count（7.6×109/L>6.54×109/L,P=0.005）,higher blood homocysteine（15 umo L/L>13umo L/L,P= 0.021）was statistically significant;gender,occupation,education level,history of hypertension,history of diabetes,ejection fraction,body mass index,total cholesterol,total triglycerides,total bilirubin,low-density lipoprotein cholesterol,high density There were no statistically significant differences in lipoprotein cholesterol and albumin between the two groups.3.Serum s ST2 level and debilitating effect in CHF patients3.1 Univariate analysis of frailty between serum s ST2 and CHF patientsThe results showed that the serum s ST2 concentration in the frail group was significantly higher than that in the non-frail group（111.74pg/m L>53.49pg/m L,P=0.001）.3.2 Multivariate analysis of frailty in serum s ST2 and CHF patientsThe results showed that elevated serum s ST2 levels increased the risk of frailty in CHF patients（OR=1.032,P<0.001）;Increasing age will increase the risk of frailty in CHF patients（OR=1.065,P=0.02）.Cardiac function,NT-pro BNP,high-sensitivity C-reactive protein,glomerular filtration rate,white blood cell count and blood homocysteine were not statistically significant.3.3 Correlation between serum s ST2 and the age of CHF patientsThe comparison of serum s ST2 levels in different age groups showed that the youth group was lower than the middle-aged group（65.15pg/m L<77.9pg/m L,adjusted P=2.223）,and the youth group was lower than the old group（65.15pg/m L<81.53pg）./m L,adjusted P=2.838),the middle-aged group was lower than the elderly group（77.9pg/m L<81.53pg/m L,adjusted P=1.863）but not statistically significant.Spearman correlation analysis showed that age was positively correlated with serum s ST2level（r=0.076,P=0.421）but not statistically significant.3.4 Difference comparison of serum s ST2 levels in different subgroupsComparison of serum s ST2 levels in four subgroups of patients showed that group A was lower than group C（50pg/m L<100.86pg/m L,P=0.001）,and group A was lower than group D（50pg/m L<125.86pg/m L）.,P<0.001),group B was lower than group C（47.96pg/m L<100.86pg/m L,P=0.031）,group B was lower than group D（47.96pg/m L<125.86pg/m L,P=0.006）statistically significant.There was no significant difference in serum s ST2 levels between groups A and B,and between groups C and D.3.5 Correlation between serum s ST2 level and CFS score in CHF patientsSpearman correlation analysis showed that the frailty score using CFS scale was positively correlated with serum s ST2 level（r=0.619,P<0.001）,which was statistically significant.4.The diagnostic value of serum s ST2 level for frailty in CHF patientsROC curve analysis,the results showed that the area under the ROC curve was 0.819,P<0.05,95%CI（0.743,0.895）,when serum s ST2≥86.48pg/m L,the sensitivity of predicting frailty was 69.4%,and the specificity was 83%,the maximum Youden index is 0.524.Conclusion:1.Elevated serum s ST2 level will increase the risk of frailty in CHF patients,and the higher the serum s ST2 level,the higher the CFS score.2.Serum s ST2 level may be a potential biomarker for the diagnosis of frailty in CHF patients. |
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