Relationship Between Prognosis And CAR,NT-pro BNP In Elderly Patients With HFPEF

Objective:Scholars agree that HFp EF is closely related to "comorbidity-inflammation".The C-reactive protein-to-albumin ratio(CAR)is a new systemic inflammatory marker that reflects the balance between CRP and albumin levels and is more sensitive than these two parameters used separately to assess the inflammatory process.The clinical importance of CAR in HFp EF is unclear and the corresponding literature is lacking.This study aims to explore whether the prognosis of elderly patients with HFp EF is related to CAR,whether CAR can be used as a marker to predict their prognosis,and to verify the relationship between the prognosis of elderly patients with HFp EF and NT-pro BNP.Method:According to the diagnostic criteria,inclusion criteria and exclusion criteria of HFp EF,245 elderly patients with HFp EF were selected from the patients hospitalized in the Qinghai University Affiliated Hospital from September 2019 to September 2020.The general information(age,comorbidities,etc.),laboratory test indicators(CRP,Alb,NT-pro BNP,etc.)and echocardiographic indicators(LVEF,etc.)of the patients were collected.The longest follow-up after discharge was 12 months,with all-cause death and heart failure rehospitalization as the primary end points.Those who completed the follow-up were divided into non-end-point event group and endpoint event group,and the general data,laboratory indicators and echocardiographic indicators were compared.Cox regression was used to analyze the relationship between end-point events,all-cause death,heart failure rehospitalization and CAR,NTpro BNP in elderly patients with HFp EF.Result:1.There were statistically significant differences between the two groups in CAR,CRP,albumin,NT-pro BNP,age,comorbidities,and NYHA classification.Compared with the non-endpoint event group,the endpoint event group had higher levels of CRP and NT-pro BNP,lower albumin level,greater CAR value,older age,more elderly,more comorbidities,NYHA class was higher.2.Univariate Cox regression analysis in this study found that the endpoint events and heart failure rehospitalization of elderly HFp EF patients were significantly correlated with CAR,CRP,albumin,NT-pro BNP,number of comorbidities,age,and NYHA class(P<0.05),while the correlation with gender was not significant.All-cause death was significantly correlated with CAR,CRP,NT-pro BNP,age,number of comorbidities,and NYHA classification(P<0.05),but not with albumin and gender.Multivariate Cox regression analysis found that the endpoint events and all-cause mortality of elderly HFp EF patients were significantly correlated with age and the number of comorbidities(P<0.05),while the correlation with CAR,CRP,albumin,NTpro BNP,gender,and NYHA classification was not significant.Heart failure rehospitalization was significantly correlated with NT-pro BNP,age,and number of comorbidities(P<0.05),but not with CAR,CRP,albumin,gender,and NYHA class.3.After excluding CRP,albumin,and gender,multivariate Cox regression analysis found that:(1)Risk of end-point events in elderly patients with HFp EF:CAR≥0.6 was 1.603 times,and Age≥80 years was 3.443 times,and the number of comorbidities≥5 was2.129 times,and 2.065 times for those with higher NYHA grades(III/IV).Visible endpoint events were significantly correlated with large CAR value(≥0.6),advanced age(≥80 years old),more comorbidities(≥5),and poor cardiac function(NYHA class III/IV)(P<0.05),but the correlation with high NT-pro BNP level(≥4800ng/l)was not significant.(2)Risk of all-cause mortality in elderly patients with HFp EF:CAR≥0.6 was5.043 times,and NT-pro BNP ≥ 4800ng/l was 12.447 times,and the number of comorbidities ≥ 5 cases was 3.566 times.It can be seen that all-cause death is significantly correlated with high CAR value(≥0.6),high NT-pro BNP level(≥4800ng/l),and more comorbidities(≥5)(P<0.05),while it is significantly associated with advanced age(≥80 years old)and poor cardiac function(NYHA class III/IV)not obvious.(3)Risk of heart failure readmission in elderly patients with HFp EF:CAR≥0.6was 1.556 times,and Age ≥ 80 years old was 4.723 times,and the number of comorbidities≥5 was 3.188 times,and 2.258 times for those with higher NYHA grades(III/IV).It can be seen that rehospitalization of heart failure is significantly correlated with large CAR value(≥0.6),advanced age(≥80 years old),more comorbidities(≥5),and poor cardiac function(NYHA class III/IV)(P<0.05),while the correlation with high NT-pro BNP level(≥4800 ng/l)was not significant.Conclusion:1.The prognosis of elderly patients with HFp EF related to CAR,and CAR is expected to be a marker for predicting their prognosis.2.The prognosis of elderly patients with HFp EF may be related to NT-pro BNP.3.The more comorbidities,the older,and the worse the cardiac function of elderly HFp EF patients,the worse the prognosis.