Worsening Renal Function Defined as an Absolute Increase in Serum Creatinine Is a Biased Metric for the Study of Cardio-Renal Interactions
Worsening Renal Function Defined as an Absolute Increase in Serum Creatinine Is a Biased Metric for the Study of Cardio-Renal Interactions
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DOI：
10.1159/000316038
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发表时间：
2010-01-01
期刊：
影响因子：
1.9
通讯作者：
Shannon, Richard P.
中科院分区：
文献类型：
--
作者：
Testani, Jeffrey M.;McCauley, Brian D.;Shannon, Richard P.
目的：失代偿性心力衰竭治疗期间肾功能（WRF）恶化，通常定义为血清肌酐绝对增加>= 0.3 mg/dl，已在多项研究中报告为强不良预后因素。我们假设WRF的定义因基线肾功能而存在偏倚，继发于肌酐和肾功能之间的指数关系。方法：我们回顾了出院诊断为心力衰竭的连续入院病例。将肌酐升高>= 0.3 mg/dl（WRFCREAT）与GFR降低>= 20%（WRFGFR）进行比较。结果：总的来说，993名住院患者符合资格。WRFCREAT发生率为31.5%，WRFGFR发生率为32.7%。WRFCREAT和WRFGFR与基线肾功能呈相反的关系（OR = 1.9 vs. OR = 0.51，p < 0.001）。两种定义与30天时死亡的未校正相关性相似[WRFGFR OR = 2.3（95% CI 1.1-4.8），p = 0.026; WRFCREAT OR = 2.1（95% CI 1.0-4.4），p = 0.047]。对照基线肾功能不全，WRFGFR在预测死亡率方面逐渐增加（p = 0.009）;然而，WRFCREAT没有增加（p = 0.11）。结论：WRF，定义为血清肌酐的绝对变化，受基线肾功能严重偏倚。在未来的心肾相互作用研究中，应考虑WRF的替代定义。版权所有（C）2010 S. Karger AG，巴塞尔
Objectives: Worsening renal function (WRF) during the treatment of decompensated heart failure, frequently defined as an absolute increase in serum creatinine >= 0.3 mg/dl, has been reported as a strong adverse prognostic factor in several studies. We hypothesized that this definition of WRF is biased by baseline renal function secondary to the exponential relationship between creatinine and renal function. Methods: We reviewed consecutive admissions with a discharge diagnosis of heart failure. An increase in creatinine >= 0.3 mg/dl (WRFCREAT) was compared to a decrease in GFR >= 20% (WRFGFR). Results: Overall, 993 admissions met eligibility. WRFCREAT occurred in 31.5% and WRFGFR in 32.7%. WRFCREAT and WRFGFR had opposing relationships with baseline renal function (OR = 1.9 vs. OR = 0.51, respectively, p < 0.001). Both definitions had similar unadjusted associations with death at 30 days [WRFGFR OR = 2.3 (95% CI 1.1-4.8), p = 0.026; WRFCREAT OR = 2.1 (95% CI 1.0-4.4), p = 0.047]. Controlling for baseline renal insufficiency, WRFGFR added incrementally in the prediction of mortality (p = 0.009); however, WRFCREAT did not (p = 0.11). Conclusions: WRF, defined as an absolute change in serum creatinine, is heavily biased by baseline renal function. An alternative definition of WRF should be considered for future studies of cardio-renal interactions. Copyright (C) 2010 S. Karger AG, Basel