Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)
Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)
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DOI：
10.1093/eurheartj/ehi859
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发表时间：
2006-05-01
影响因子：
39.3
通讯作者：
Ticho, B
中科院分区：
文献类型：
--
作者：
Cowie, MR;Komajda, M;Ticho, B
目的 确定因失代偿性心力衰竭 (HF) 住院患者中肾功能恶化 (WRF) 的患病率和危险因素，以及与随后的再住院和死亡率的关系。 方法和结果 我们前瞻性招募了来自 8 个欧洲国家的 299 名患者（平均年龄 68 岁，74% 为男性）。心力衰竭的定义采用欧洲心脏病学会标准，但仅限于入院时射血分数为 26 μmol/L（约 0.3 mg/dL）病史的患者。 6 个月内的随访完成率为 95%。近三分之一的患者[248 名患者中的 72 名，29% (95% CI 26-32%)] 在住院期间出现 WRF，不包括出现可能损害肾功能的重大院内并发症的患者。该组中 WRF 的风险与入院时血清肌酐水平 [比值比 (OR) 3.02 (95% CI 1.58-5.76)]、肺水肿 [OR 3.35 (1.79-6.27)] 和房颤病史 [OR 0.35 (0.18-0.67)] 独立相关。尽管WRF患者的死亡率没有显着增加，但住院时间延长了2天[中位11天（90%范围（4-41）vs. 9天（4-34），P=0.006]。两组再住院率相似。结论 WRF在欧洲医院收治的失代偿性心力衰竭患者中很常见。此类患者入院时间较长，但死亡率和再住院率与无代偿期心衰的患者相似。 WRF（如果排除出现重大院内并发症的患者）。
Aims To determine the prevalence and risk factors for worsening renal function (WRF) among patients hospitalized for decompensated heart failure (HF) and the association with subsequent re-hospitalization and mortality.Methods and results We prospectively enrolled 299 patients across eight European countries (mean age 68, 74% men). HF was defined using the European Society of Cardiology criteria, but only patients with a history of ejection fraction 26 mu mol/L (approximate to 0.3 mg/dL) from admission. Follow-up was 95% complete to 6 months. Nearly one-third of patients [72 of 248 patients, 29% (95% CI 26-32%)] developed WRF during hospitalization, excluding patients who had a major in-hospital complication likely to compromise renal function. The risk of WRF in this group was independently associated with serum creatinine levels on admission [odds ratio (OR) 3.02 (95% CI 1.58-5.76)], pulmonary oedema [OR 3.35 (1.79-6.27)], and a history of atrial fibrillation [OR 0.35 (0.18-0.67)]. Although the mortality of WRF patients was not increased significantly, the length of stay was 2 days longer [median 11 days (90% range (4-41) vs. 9 days (4-34), P=0.006]. The re-hospitalization rate was similar in both groups.Conclusion WRF is common in patients admitted to European hospitals with decompensated HF. Such patients have longer duration admissions, but a similar mortality and re-hospitalization rate to those without WRF (if patients experiencing a major in-hospital complication are excluded).