Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure.
Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure.
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DOI：
10.1161/jaha.123.031453
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发表时间：
2023-11-07
影响因子：
5.4
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中科院分区：
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利钠肽已被推荐作为心力衰竭患者诊断和预后的生物标志物，并且在急性肾损伤的情况下通常会升高。我们试图证明基线 NT-proBNP（N 末端 B 型利钠肽原）升高与中重度急性肾损伤患者的不良肾脏结局之间的关联。我们回顾了 2011 年 9 月至 2021 年 12 月期间入住克利夫兰诊所的连续 2 期和 3 期急性肾损伤患者的电子病历。包括在肾脏咨询或透析开始前收集的 NT-proBNP 水平的患者。不良肾脏结局包括透析需求和透析依赖，定义为患者出院前 72 小时内接受透析或院内死亡。在我们的研究队列 (n=3811) 中，2521 名 (66%) 患者接受了透析，1619 名 (42%) 患者成为透析依赖者，1325 名 (35%) 患者出现院内死亡。调整心肾危险因素后，与最低四分位数相比，NT-proBNP 最高四分位数（≥18 215 pg/mL）与透析需求可能性增加（调整后比值比 [OR]，2.36 [95% CI，1.87–2.99]）、透析依赖（调整后 OR，1.89 [95% CI， 2.53–1.34]）和院内死亡率（调整后 OR，1.34 [95% CI，1.01–1.34]）。 NT-proBNP 升高与中度至重度急性肾损伤患者的透析需求风险增加、透析依赖风险增加以及院内死亡率增加相关。
Natriuretic peptides have been recommended as biomarkers for the diagnosis and prognosis of patients with heart failure and are often elevated in the setting of acute kidney injury. We sought to demonstrate the associations between increased baseline NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and adverse renal outcomes in patients with moderate‐to‐severe acute kidney injury. We reviewed electronic medical records of consecutive patients with acute kidney injury stage 2 and 3 admitted to the Cleveland Clinic between September 2011 and December 2021. Patients with NT‐proBNP levels collected before renal consultation or dialysis initiation were included. Adverse renal outcomes included dialysis requirement and dialysis dependence defined as patients undergoing dialysis within 72 hours before hospital discharge or in‐hospital mortality. In our study cohort (n=3811), 2521 (66%) patients underwent dialysis, 1619 (42%) patients became dialysis dependent, and 1325 (35%) patients had in‐hospital mortality. After adjusting for cardiorenal risk factors, compared with the lowest quartile, the highest quartile of NT‐proBNP (≥18 215 pg/mL) was associated with increased likelihood of dialysis requirement (adjusted odds ratio [OR], 2.36 [95% CI, 1.87–2.99]), dialysis dependence (adjusted OR, 1.89 [95% CI, 2.53–1.34]), and in‐hospital mortality (adjusted OR, 1.34 [95% CI, 1.01–1.34]). Increased NT‐proBNP was associated with an increased risk of dialysis requirement, becoming dialysis dependent, and in‐hospital mortality in patients with moderate‐to‐severe acute kidney injury.