Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH)
Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH)
复制标题
DOI：
10.1093/eurjhf/hfp108
复制
发表时间：
2009-09-01
影响因子：
18.2
通讯作者：
van Veldhuisen, Dirk J.
中科院分区：
文献类型：
--
作者：
Damman, Kevin;Jaarsma, Tiny;van Veldhuisen, Dirk J.
出院后肾功能恶化(WRF)对心力衰竭患者预后的影响尚不清楚。我们评估了1023名心力衰竭患者入院、出院、出院后6个月和12个月的肾小球滤过率(EGFR)和血清肌酐。肾功能恶化被定义为血清肌酐增加26.5MU/L和25%。主要终点是所有原因死亡率和心力衰竭入院人数的组合。患者的平均年龄为71+/-11岁，其中62%为男性。入院时平均EGFR为55+/-21mL/min/1.73m(2)。出院后0~6个月和6~12个月的院内WRF发生率分别为11%、16%和9%。在多因素标志性分析中，危险比(HR)1.63(1.10~2.40)、住院期间危险比(HR)2.06(1.13~3.74)、0~6个月期间危险比(HR)5.03(2.13~11.88)、P<；0.001。院内和院外肾功能恶化与心力衰竭患者预后不良独立相关，提示心力衰竭患者出院后应长期监测肾功能。
The effect of worsening renal function (WRF) after discharge on outcome in patients with heart failure is unknown.We assessed estimated glomerular filtration rate (eGFR) and serum creatinine at admission, discharge, and 6 and 12 months after discharge, in 1023 heart failure patients. Worsening renal function was defined as an increase in serum creatinine of > 26.5 mu mol/L and > 25%. The primary endpoint was a composite of all-cause mortality and heart failure admissions. The mean age of patients was 71 +/- 11 years, and 62% was male. Mean eGFR at admission was 55 +/- 21 mL/min/1.73 m(2). In-hospital WRF occurred in 11% of patients, while 16 and 9% experienced WRF from 0 to 6, and 6 to 12 months after discharge, respectively. In multivariate landmark analysis, WRF at any point in time was associated with a higher incidence of the primary endpoint: hazard ratio (HR) 1.63 (1.10-2.40), P = 0.014 for in-hospital WRF, HR 2.06 (1.13-3.74), P = 0.018 for WRF between 0-6 months, and HR 5.03 (2.13-11.88), P < 0.001 for WRF between 6-12 months.Both in- and out-hospital worsening of renal function are independently related to poor prognosis in patients with heart failure, suggesting that renal function in heart failure patients should be monitored long after discharge.