Prognostic impact of systemic inflammatory diseases in elderly patients with congestive heart failure
Prognostic impact of systemic inflammatory diseases in elderly patients with congestive heart failure
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DOI：
10.1093/qjmed/hct205
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发表时间：
2014-02-01
影响因子：
13.3
通讯作者：
Brunner-La Rocca, H. -P.
中科院分区：
文献类型：
--
作者：
Burkard, T.;Pfister, O.;Brunner-La Rocca, H. -P.
背景和目的：炎症是充血性心力衰竭（CHF）的病理生理学的一部分。然而，鲜为人知的是，全身炎症性疾病（SID）的存在下，定义为炎症综合征与体质症状和参与至少两个器官的共同发病的临床过程和预后的患者与CHF.Methods和结果的影响：这是一个分析所有622例患者包括在时间-CHF。随访18个月后，比较有和无SID患者的结局。主要终点为无全因住院生存率。次要终点为总生存期和CHF无住院生存期。基线时，38例患者有SID病史（6.1%）。与无SID的患者相比，这些患者的N末端脑钠肽前体水平更高，肾功能更差。SID是不良结局的危险因素[主要终点：风险比（HR）= 1.73（95%置信区间：1.18-2.55，P = 0.005）;生存期：HR = 2.60（1.49-4.55，P = 0.001）; CHF无住院生存期：HR = 2.3（1.45-3.65，P < 0.001）]。在多变量模型中，SID仍然是生存率和CHF无住院生存率的最强独立危险因素。结论：在老年CHF患者中，SID是独立伴随不良结局的因素。鉴于老年人群中SID的患病率不断增加，这些发现对于风险分层和患者管理具有临床重要意义。
Background and aims: Inflammation is part of the pathophysiology of congestive heart failure (CHF). However, little is known about the impact of the presence of systemic inflammatory disease (SID), defined as inflammatory syndrome with constitutional symptoms and involvement of at least two organs as co-morbidity on the clinical course and prognosis of patients with CHF.Methods and results: This is an analysis of all 622 patients included in TIME-CHF. After an 18 months follow-up, outcomes of patients with and without SID were compared. Primary endpoint was all-cause hospitalization free survival. Secondary endpoints were overall survival and CHF hospitalization free survival. At baseline, 38 patients had history of SID (6.1%). These patients had higher N-terminal pro brain natriuretic peptide and worse renal function than patients without SID. SID was a risk factor for adverse outcome [primary endpoint: hazard ratio (HR) = 1.73 (95% confidence interval: 1.18-2.55, P = 0.005); survival: HR = 2.60 (1.49-4.55, P = 0.001); CHF hospitalization free survival: HR = 2.3 (1.45-3.65, P < 0.001)]. In multivariate models, SID remained the strongest independent risk factor for survival and CHF hospitalization free survival.Conclusions: In elderly patients with CHF, SID is independently accompanied with adverse outcome. Given the increasing prevalence of SID in the elderly population, these findings are clinically important for both risk stratification and patient management.