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目的:探讨血清尿素氮水平对心力衰竭患者院内死亡的评估价值。方法:回顾性分析中国医科大学附属盛京医院2013年1月至2018年12月9 459例心力衰竭患者的临床资料。其中，发生院内死亡296例（死亡组），未发生院内死亡9 163例（存活组）。收集患者的临床资料，包括一般情况、既往疾病史、体格检查、实验室检查及相关物理检查等。相关性采用Pearson相关分析；采用多因素Logistic回归分析确定影响心力衰竭患者院内死亡的独立危险因素；绘制受试者工作特征（ROC）曲线，确定尿素氮预测心力衰竭患者院内死亡的最佳界值。结果:心力衰竭患者院内病死率为3.1%（296/9 459）。死亡组和存活组年龄、高血压率、糖尿病率、心房颤动史率、吸烟史率、血红蛋白、白蛋白、糖化血红蛋白、尿素氮、肌酐、尿酸、血清钾、血清钠、肌钙蛋白I、N末端脑利钠肽前体（NT-proBNP）、左室射血分数（LVEF）比较差异有统计学意义（n P<0.01或0.05）。Pearson相关分析结果显示，尿素氮与年龄、冠心病、高血压、糖尿病、糖化血红蛋白、肌酐、尿酸、血清钾、肌钙蛋白I、NT-proBNP、LVEDV、LVESV呈正相关（n r ＝ 0.130、0.024、0.053、0.128、0.033、0.739、0.468、0.377、0.065、0.432、0.084、0.101，n P<0.01或<0.05），与性别、心房颤动史、血红蛋白、血小板、白蛋白、总胆固醇、LDL-C、血清钠、LVEF呈负相关（n r ＝ -0.033、-0.063、-0.272、-0.077、-0.188、-0.070、- 0.071、- 0.199、- 0.113，n P0.05）。多因素Logistic回归分析结果显示，年龄、高血压、白蛋白、尿素氮、肌钙蛋白I和NT-proBNP是影响心力衰竭患者院内死亡的独立危险因素（n OR ＝ 1.018、0.613、0.924、1.082、1.340和1.005，95%n CI 1.002～1.033、0.427～0.881、0.889～0.961、1.040～1.126、1.111～1.617和1.003～1.007，n P<0.05或<0.01）。ROC曲线分析结果显示，尿素氮预测心力衰竭患者院内死亡的曲线下面积（AUC）为0.737（95%n CI 0.728～0.748），最佳界值为11.41 mmol/L，敏感度为60.16%，特异度为77.01%；NT-proBNP预测心力衰竭患者院内死亡的AUC为0.726（95% n CI 0.712～0.740），与尿素氮AUC比较差异无统计学意义（n Z＝1.055，n P＝0.291）。n 结论:血清尿素氮升高与心力衰竭患者院内死亡增加独立相关，其预测心力衰竭患者院内死亡的最佳界值是11.41 mmol/L。“,”Objective:To investigate the value of serum urea nitrogen on in-hospital death in patients with heart failure.Methods:The clinical data of 9 459 patients with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were retrospectively analyzed. Among them, 296 cases died in hospital (death group) and 9 163 cases survived (survival group). The clinical data of patients were collected, including general condition, disease history, physical examination, laboratory indicators and relevant physical examination, etc. Correlation was finished with Pearson correlation analysis. Multivariate Logistic regression analysis was used to determine independent risk factors for in-hospital death in patients with heart failure. Receiver operating characteristic (ROC) curve was used to determine the optimal predictive threshold of urea nitrogen for in-hospital death.Results:The in-hospital mortality in patients with heart failure was 3.1% (296/9 459). There were statistical differences in age, hypertension rate, diabetes rate, a history of atrial fibrillation rate, smoking history rate, hemoglobin, albumin, glycosylated hemoglobin, urea nitrogen, creatinine, uric acid, serum potassium, serum sodium, troponin I, N terminal brain natriuretic peptide precursor (NT-proBNP), left ventricular ejection fraction (LVEF) between death group and survival group (n P<0.01 or 0.05). Pearson correlation analysis result showed that the urea nitrogen was positively correlated with age, coronary heart disease, hypertension, diabetes, glycosylated hemoglobin, creatinine, uric acid, serum potassium, troponin I, NT-proBNP, LVEDV and LVESV (n r = 0.130, 0.024, 0.053, 0.128, 0.033, 0.739, 0.468, 0.377, 0.065, 0.432, 0.084 and 0.101; n P<0.01 or <0.05); and the urea nitrogen was negatively correlated with gender, history of atrial fibrillation, hemoglobin, platelet, albumin, total cholesterol, LDL-C, serum sodium and LVEF (n r = -0.033, -0.063, -0.272, -0.077, -0.188, -0.070, -0.071, -0.199 and -0.113, n P0.05). Multivariate Logistic regression analysis result showed that age, hypertension, albumin, urea nitrogen, troponin I and NT-proBNP were independent risk factors for in-hospital death in patients with heart failure (n OR = 1.018, 0.613, 0.924, 1.082, 1.340 and 1.005; 95% n CI 1.002 to 1.033, 0.427 to 0.881, 0.889 to 0.961, 1.040 to 1.126, 1.111 to 1.617 and 1.003 to 1.007; n P<0.05 or <0.01). ROC curve analysis result showed that the area under the curve (AUC) of urea nitrogen for prediction of in-hospital death in patients with heart failure was 0.737 (95%n CI 0.728 to 0.748), and the optimal threshold value was 11.41 mmol/L, with a sensitivity of 60.16% and a specificity of 77.01%; the AUC of NT-proBNP for prediction of in-hospital death in patients with heart failure was 0.726 (95% n CI 0.712 to 0.740), and there was no statistical difference in the AUC between urea nitrogen and NT-proBNP (n Z=1.055, n P=0.291).n Conclusions:Elevated urea nitrogen level is independently associated with an increase in in-hospital mortality in patients with heart failure, and the optimal threshold for predicting in-hospital death is 11.41 mmol/L.