Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure
Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure
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DOI：
10.1177/2050312114552093
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发表时间：
2014-01-01
影响因子：
2.3
通讯作者：
Moser, Debra K.
中科院分区：
文献类型：
--
作者：
Alhurani, Abdullah S.;Dekker, Rebecca;Moser, Debra K.
目的：心力衰竭的高死亡率和高发病率仍未得到很好的解释。一些心理社会因素已经被研究并解释了其中的一些风险，但其他因素，如压力，在心力衰竭方面仍然很大程度上没有被研究。本研究旨在(1)研究应激与6个月心脏无事件生存率的关系；(2)探讨应激与唾液皮质醇的关系；(3)探讨唾液皮质醇水平与6个月心脏无事件生存率的关系。使用简明的知觉压力量表测量压力。皮质醇是从未经刺激的全唾液中测得的。COX回归分析用于确定应激是否预测无事件生存率，以及唾液皮质醇是否预测无事件生存率。结果：应激不是心力衰竭患者无事件生存的显著预测因素(心率=1.06；95%可信区间=0.95-1.81；p=0.32)。唾液皮质醇是未调整模型(心率=2.3；95%可信区间=0.99-5.927；p=0.05)中无事件生存的重要预测因子，但在调整模型中不是。压力(Beta 1.06；95%可信区间=0.95-1.18；p=0.32)不是唾液皮质醇水平的显著预测因子。结论：压力是一个复杂的现象，我们对压力的测量可能没有很好地捕捉到它。或者，作用于心力衰竭的身体应激源产生神经激素激活水平，以掩盖心理社会应激源的影响，或应激与通过另一种结构调节的结果的间接关联。需要进一步的研究来调查心力衰竭患者的压力，以提供明确的答案。
Objectives: The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival.Method: A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol.Results: Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95-1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99-5.927; p = 0.05), but not in the adjusted model. Stress (beta 1.06; 95% confidence interval = 0.95-1.18; p = 0.32) was not a significant predictor of salivary cortisol level.Conclusion: Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers.