Pulmonary hypertension as an independent predictor of cardiovascular mortality and events in hemodialysis patients
Pulmonary hypertension as an independent predictor of cardiovascular mortality and events in hemodialysis patients
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肺动脉高压作为血液透析患者心血管死亡率和事件的独立预测因子
DOI：
10.1007/s11255-013-0486-z
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发表时间：
2014-01-01
影响因子：
2
通讯作者：
Shi, Wei
中科院分区：
文献类型：
--
作者：
Li, Zhilian;Liu, Shuangxin;Shi, Wei
血液透析患者的心血管（CV）发病率和死亡率风险增加。肺动脉高压（PH）最近被报告为维持性血液透析（MHD）患者的一种新的实体和未被识别的威胁，PH是否预测该人群的CV死亡率和事件仍不清楚。本研究的目的是确定PH在预测MHD患者的CV死亡率和事件的前瞻性队列中的价值。我们研究了中国广州广东省人民医院血液净化中心的278例MHD患者（98例伴PH，180例不伴PH）。所有患者均随访2年，在生存分析中，我们考虑了至死亡或首次心血管事件的时间。终点为全因死亡率、CV死亡率和CV事件。在278例MHD患者中，53例（19.1%）死于所有原因，28例（10.1%）死于心血管事件（52.8%的死亡原因），87例（31.3%）有新发心血管事件。生存曲线显示PH组的全因死亡率、CV死亡率和新发CV事件均高于非PH组。在多变量考克斯比例风险模型中，全因死亡率、CV死亡率和CV事件的校正HR分别为1.85 [95%置信区间（CI）1.03-3.34]、2.36我们的研究表明PH是MHD患者全因死亡率和CV死亡率及事件的独立预测因子。我们建议在MHD患者中评估SPAP，以分层死亡和CV事件的风险。
Hemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. Pulmonary hypertension (PH) has been recently reported as a new entity and unrecognized threat in maintenance hemodialysis (MHD) patients, whether PH predicts CV mortality and events in this population remains unknown. The aim of the present study was to determine the value of PH in predicting CV mortality and events in a prospective cohort of MHD patients.We studied 278 MHD patients (98 with and 180 without PH) in Guangdong General Hospital Blood Purification Center, Guangzhou, China. All patients had been followed up for 2 years, and in survival analysis, we considered time to death or first cardiovascular event. The endpoints were all-cause mortality, CV mortality and CV events. PH was defined as systolic pulmonary artery pressure (SPAP) a parts per thousand yen 35 mmHg as determined by Doppler echocardiographic evaluation.Of the 278 MHD patients, 53 (19.1 %) died as a result of all causes, 28 (10.1 %) died from CV events (52.8 % of causes of death), and 87 (31.3 %) had new-onset CV events. The survival curve showed that all-cause and CV mortality and new-onset CV events were higher in PH group than the non-PH group. In a multivariate Cox proportional hazard model, the adjusted HR for all-cause mortality, CV mortality and CV events was 1.85 [95 % confidence interval (CI) 1.03-3.34], 2.36 (95 % CI 1.05-5.31) and 2.27 (95 % CI 1.44-3.58), respectively.Our study showed that PH was an independent predictor of all-cause mortality and CV mortality and events in MHD patients. We suggest to evaluate SPAP in MHD patients in order to stratify risk of death and CV events.