Relation of Worsened Renal Function During Hospitalization for Heart Failure to Long-Term Outcomes and Rehospitalization
Relation of Worsened Renal Function During Hospitalization for Heart Failure to Long-Term Outcomes and Rehospitalization
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DOI：
10.1016/j.amjcard.2010.08.045
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发表时间：
2011-01-01
影响因子：
2.8
通讯作者：
Williams, L. Keoki
中科院分区：
文献类型：
--
作者：
Lanfear, David E.;Peterson, Edward L.;Williams, L. Keoki
心力衰竭 (HF) 住院期间肾功能 (WRF) 恶化与院内死亡率相关，但有关其与出院后长期结果关系的数据有限。 WRF 分辨率的影响也是未知的。这项回顾性研究分析了 2000 年 1 月至 2008 年 6 月期间接受大型卫生系统护理并首次出院诊断为心力衰竭的患者。根据住院期间的肌酐水平评估肾功能。第一个可用值被视为基线。 WRF 定义为与基线相比，在随后的任何住院日肌酐增加 >= 0.3 mg/dl。持续性 WRF 定义为出院时具有 WRF。比例风险回归，调整基线肾功能和潜在的混杂因素，用于评估再住院或死亡的时间。在 2,465 名存活出院的患者中，887 名 (36%) 出现了 WRF。中位随访时间为 2.1 年。在调整后的模型中，WRF 与较高的出院后死亡率或再住院率相关（风险比 [HR] 1.12，95% 置信区间 [CI] 1.02 至 1.22）。在 WRF 患者中，528 人 (60%) 患有持续性 WRF，而 359 人 (40%) 已康复。持续性 WRF 与较高的出院后事件发生率显着相关（HR 1.14，95% CI 1.02 至 1.27），而短暂性 WRF 仅显示出不显着的风险趋势（HR 1.09，95% CI 0.96 至 1.24）。总之，在因心力衰竭住院后幸存的患者中，WRF 与长期死亡率和再住院率增加相关，特别是在出院时肾功能未恢复的情况下。 (c) 2011 Elsevier Inc. 保留所有权利。 (Am J Cardiol 2011；107:74-78)
Worsened renal function (WRF) during heart failure (HF) hospitalization is associated with in-hospital mortality, but there are limited data regarding its relation to long-term outcomes after discharge. The influence of WRF resolution is also unknown. This retrospective study analyzed patients who received care from a large health system and had a primary hospital discharge diagnosis of HF from January 2000 to June 2008. Renal function was estimated from creatinine levels during hospitalization. The first available value was considered baseline. WRF was defined a creatinine increase >= 0.3 mg/dl on any subsequent hospital day compared to baseline. Persistent WRF was defined as having WRF at discharge. Proportional hazards regression, adjusting for baseline renal function and potential confounding factors, was used to assess time to rehospitalization or death. Of 2,465 patients who survived to discharge, 887 (36%) developed WRF. Median follow-up was 2.1 years. In adjusted models, WRF was associated with higher rates of postdischarge death or rehospitalization (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02 to 1.22). Of those with WRF, 528 (60%) had persistent WRF, whereas 359 (40%) recovered. Persistent WRF was significantly associated with higher postdischarge event rates (HR 1.14, 95% CI 1.02 to 1.27), whereas transient WRF showed only a nonsignificant trend toward risk (HR 1.09, 95% CI 0.96 to 1.24). In conclusion, in patients surviving hospitalization for HF, WRF was associated with increased long-term mortality and rehospitalization, particularly if renal function did not recover by the time of discharge. (c) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:74-78)