Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function
Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function
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DOI：
10.1161/circheartfailure.111.963413
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发表时间：
2012-01-01
影响因子：
9.7
通讯作者：
Cas, Livio Dei
中科院分区：
文献类型：
--
作者：
Metra, Marco;Davison, Beth;Cas, Livio Dei
背景：肾功能恶化（WRF），传统上定义为血清肌酐水平升高>= 0.3 mg/dL，是急性心力衰竭（AHF）患者的常见发现，并且在一些但不是所有的研究中与较差的预后相关。我们假设这些差异可能是由AHF患者的WRF和充血之间的相互作用引起的。方法和结果：我们在住院期间每天测量血清肌酐水平，并评估599例连续入院的AHF患者出院时充血迹象的持久性。1年后，他们的出院后死亡率和AHF再入院死亡率分别为13%和43%。根据是否发生WRF及出院时是否存在>= 1的充血征象再将患者分为4组。有WRF且无充血的患者与无WRF且无充血的患者预后相似，而单纯持续性充血的患者和同时有WRF和充血的患者的死亡或死亡或再入院AHF的风险增加(风险比，5.35；95%可信区间，单变量分析3.0-9.55；风险比，2.44；死亡率多变量分析95%可信区间，1.24-4.18；风险比，2.14；单变量分析95%置信区间为1.39 ~ 3.3；风险比为1.39；在死亡率和再住院率的多变量分析中，95%置信区间为0.88-2.2)。结论：当使用系列血清肌酐测量检测wrf时，单独wrf不是AHF患者预后的独立决定因素。当它发生在持续充血症状的患者时，它具有附加的预后价值。（中国心脏衰竭杂志，2012;5:54 -62）
Background-Worsening renal function (WRF), traditionally defined as an increase in serum creatinine levels >= 0.3 mg/dL, is a frequent finding in patients with acute heart failure (AHF) and has been associated with poorer outcomes in some but not all studies. We hypothesized that these discrepancies may be caused by the interaction between WRF and congestion in AHF patients.Methods and Results-We measured serum creatinine levels on a daily basis during the hospitalization and assessed the persistence of signs of congestion at discharge in 599 consecutive patients admitted at our institute for AHF. They had a postdischarge mortality and mortality or AHF readmission rates of 13% and 43%, respectively, after 1 year. Patients were subdivided into 4 groups according to the development or not of WRF and the persistence of >= 1 sign of congestion at discharge. Patients with WRF and no congestion had similar outcomes compared with those with no WRF and no congestion, whereas the risk of death or of death or AHF readmission was increased in the patients with persistent congestion alone and in those with both WRF and congestion (hazard ratio, 5.35; 95% confidence interval, 3.0-9.55 at univariable analysis; hazard ratio, 2.44; 95% confidence interval, 1.24-4.18 at multivariable analysis for mortality; hazard ratio, 2.14; 95% confidence interval, 1.39-3.3 at univariable analysis; and hazard ratio, 1.39; 95% confidence interval, 0.88-2.2 at multivariable analysis for mortality and rehospitalizations).Conclusions-WRF alone, when detected using serial serum creatinine measurements, is not an independent determinant of outcomes in patients with AHF. It has an additive prognostic value when it occurs in patients with persistent signs of congestion. (Circ Heart Fail. 2012; 5: 54-62.)