Prediction And Evaluation Of Renal Function Deterioration In Patients With Heart Failure After Short-term Intravenous Diuretic Use By CA125 Combined With Glomerular Filtration Rate

Objective:Using CA125 combined with glomerular filtration rate(GFR),explore the independent risk factors of renal function deterioration in patients with heart failure after using diuretics.According to these independent risk factors,a nomogram prediction model was established to predict the risk of renal function deterioration in patients.Methods:The clinical data of 226 patients treated with diuretics in the Cardiovascular Department of the Second Affiliated Hospital of Nanchang University from June 2019 to June 2022 were retrospectively collected.CA125 and estimated glomerular filtration rate were dichotomized at 23U/ml and 60 ml/min/1.73m2,respectively,and grouped as follows:C1=CA]25>23 and eGFR<60;C2=CA125<23、eGFR<60:C3=CA125>23、eGFR>60;And C4=ca125<23,eGFR>60.According to the changes of short-term renal function,the patients were divided into non-renal function deterioration group and renal function deterioration group.The IBM SPSS 25.0 statistical software was used to analyze the differences among groups for the above factors that may lead to the deterioration of renal function,and the binary Logistic regression analysis was used for univariate and multivariate analysis.P<0.05 was considered to be statistically significant difference.Variables with statistical differences in single factor analysis were included in multi-factor Logistic regression analysis,and the variables with statistical differences in multi-factor Logistic regression analysis were used as prediction variables of the prediction model for model development.According to the regression coefficient,the corresponding nomogram was drawn.After the nomogram model was evaluated,Bootstrap internal re-sampling verification was performed.Results:In this study,226 patients with heart failure were treated with intravenous diuretics after admission.137 patients had stable or improved renal function,and 89 patients had worse renal function(WRF).Independent risk factors for short-term renal function deterioration were systolic blood pressure(OR=1.016,95%Confidence interval(CI):1.005-1.028,P=0.006),Hemoglobin(Hb)(OR=0.974;95%CI:0.958-0.990;P=0.001),CA125/eGFR complex subgroup and RAS inhibitor according to multivariate binary Logistic regression analysis.The initial C-statistics for the nomogram in the modeled samples was 0.754;The calibration curve of the nomogram model after internal re-sampling by Bootstrap is close to the ideal line,and the average absolute error of the actual risk probability and the predicted risk probability is 0.020.Conclusions:This study found that the SBP,Hb,CA125/eGFR combination group,and the use of RAS inhibitors were independent risk factors for worsening renal function following short-term inpatient diuretic therapy in HF patients.The nomogram model established by these four independent risk factors has good discrimination and calibration degree.It can guide clinical doctors to make clinical decisions in clinical work.For patients with high risk,renal function should be closely monitored and intervention should be made as soon as possible.