Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers.
Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers.
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DOI：
10.12659/msm.902786
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发表时间：
2017-07-10
期刊：
影响因子：
--
通讯作者：
Ağır AA
中科院分区：
文献类型：
--
作者：
Baydemir C;Ural D;Karaüzüm K;Balci S;Argan O;Karaüzüm I;Kozdağ G;Ağır AA
评估急性心力衰竭（AHF）患者出院时的全因死亡和再住院风险是一项重要任务，因为它们需要不同的管理策略。在伴有肾功能不全的AHF患者中，采用最佳药物治疗可能会改变这两个终点的预测因子。本研究的目的是评估经最佳药物治疗出院的肾功能不全的急性心力衰竭患者的长期预后预测因素。该研究是回顾性进行的。研究组包括225例中重度肾功能不全的AHF患者，这些患者在Kocaeli大学医院心脏病门诊住院，出院时接受β受体阻滞剂和ACE抑制剂或血管紧张素II受体阻滞剂治疗。使用考克斯回归分析评估总死亡率和频繁再住院（随访期间≥3次住院）复合终点的临床、超声心动图和生化预测因子，并通过竞争风险回归分析评估每个终点的预测因子。中位随访54个月，全因死亡率为45.3%，频繁再入院率为49.8%。复合终点的相关因素包括年龄、NYHA分级、入院时呼吸频率、eGFR、低白蛋白血症、二尖瓣E/E'比值和射血分数。在竞争风险回归分析中，右侧HF、低白蛋白血症、年龄和尿酸似乎是全因死亡率的独立相关因素，而NYHA分级、NT-proBNP、二尖瓣E/E'比率和尿酸是再住院的预测因素。在接受最佳治疗的肾功能不全的AHF患者中，全因死亡率的预测因素主要与晚期HF伴右侧功能不全相关，而频繁再住院与容量超负荷相关，表现为二尖瓣E/E'比值和NT-proBNP水平升高。
Assessment of risk for all-cause mortality and re-hospitalization is an important task during discharge of acute heart failure (AHF) patients, as they warrant different management strategies. Treatment with optimal medical therapy may change predictors for these 2 end-points in AHF patients with renal dysfunction. The aim of this study was to evaluate the predictors for long-term outcome in AHF patients with kidney dysfunction who were discharged on optimal medical therapy. The study was conducted retrospectively. The study group consisted of 225 AHF patients with moderate-to-severe kidney dysfunction, who were hospitalized at Kocaeli University Hospital Cardiology Clinic and who were prescribed beta-blockers and ACE-inhibitors or angiotensin II receptor blockers at discharge. Clinical, echocardiographic, and biochemical predictors of the composite of total mortality and frequent re-hospitalization (≥3 hospitalizations during the follow-up) were assessed using Cox regression and the predictors for each end-point were assessed by competing risk regression analysis. Incidence of all-cause mortality was 45.3% and frequent readmissions were 49.8% in a median follow-up of 54 months. The associates of the composite end-point were age, NYHA class, respiration rate on admission, eGFR, hypoalbuminemia, mitral valve E/E’ ratio, and ejection fraction. In competing risk regression analysis, right-sided HF, hypoalbuminemia, age, and uric acid appeared as independent associates of all-cause mortality, whereas NYHA class, NT-proBNP, mitral valve E/E’ ratio, and uric acid were predictors for re-hospitalization. Predictors for all-cause mortality in AHF with kidney dysfunction treated with optimal therapy are mainly related to advanced HF with right-sided dysfunction, whereas frequent re-hospitalization is associated with volume overload manifested by increased mitral E/E’ ratio and NT-proBNP levels.
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影响因子：
6
作者：
Heywood, J. Thomas;Fonarow, Gregg C.;Wynne, Janet
通讯作者：
Wynne, Janet
影响因子：
4.8
作者：
O'Connor, Christopher M.;Abraham, William T.;Fonarow, Gregg C.
通讯作者：
Fonarow, Gregg C.
影响因子：
3
作者：
Tarantini, Luigi;Cioffi, Giovanni;Tavazzi, Luigi
通讯作者：
Tavazzi, Luigi
DOI：
10.1158/1078-0432.ccr-11-2097
发表时间：
2012-04-15
期刊：
Clinical cancer research : an official journal of the American Association for Cancer Research
影响因子：
--
作者：
Dignam JJ;Zhang Q;Kocherginsky M
通讯作者：
Kocherginsky M
影响因子：
13
作者：
Caldentey, Guillem;Khairy, Paul;Ducharme, Anique
通讯作者：
Ducharme, Anique