Petretta Mario, Scopacasa Franco, Fontanella Luca, Carlomagno Angelo, Baldissara Maurizio, de Simone Adriano, Petretta Maria Piera, Bonaduce Domenico
Department of Internal Medicine, Cardiology, Heart Surgery and Immunological Sciences, University of Naples Federico II, Via S Pansini no. 5, Naples, Italy.
J Cardiovasc Med (Hagerstown). 2007 Nov;8(11):909-16. doi: 10.2459/JCM.0b013e32801464b6.
The present study aimed to evaluate the prognostic value of B-type natriuretic peptide (N-proBNP), renal dysfunction and anemia in chronic heart failure (CHF) patients.
We analyzed data from a prospective cohort of 153 patients (mean age 64 years) with CHF referred to our hospital center. Clinical, echocardiographic and laboratory data were drawn during hospital recovery in all patients. Kidney dysfunction was defined as a glomerular filtration rate (GFR) < 60 ml/min and anemia as a hematocrit < 35%. After discharge, patients attended the outpatient clinic of our institution.
Kidney dysfunction was diagnosed in 37% of cases, whereas anemia was present in 25% of patients. During follow-up (median time 456 days), 32 patients died. Multivariate Cox proportional hazard model revealed that N-proBNP [hazard ratio (HR) = 1.002; P < 0.001] and GFR (HR = 0.972; P < 0.005) were significant predictors for mortality after adjustment for confounding variables. Kaplan-Maier analysis demonstrated a progressive decrease in survival from lowest to highest tertiles of N-proBNP values (log rank = 28.7; P < 0.001) and from higher to lower GFR values (log rank = 5.63; P < 0.01). Moreover, parametric survival analysis by the Weibull model demonstrated that the estimated probability of survival adjusted for N-proBNP values was higher in patients with GFR > or = 60 ml/min than in those with GFR < 60 ml/min (P < 0.001).
Increased N-proBNP and decreased kidney function, but not anemia, are independent risk factors for mortality in patients with CHF.
本研究旨在评估B型利钠肽（N-末端脑钠肽前体）、肾功能不全及贫血对慢性心力衰竭（CHF）患者的预后价值。
我们分析了我院中心收治的153例CHF患者（平均年龄64岁）的前瞻性队列数据。所有患者在住院康复期间均收集了临床、超声心动图及实验室数据。肾功能不全定义为肾小球滤过率（GFR）<60 ml/分钟，贫血定义为血细胞比容<35%。出院后，患者在我院门诊就诊。
37%的病例诊断为肾功能不全，25%的患者存在贫血。在随访期间（中位时间456天），32例患者死亡。多变量Cox比例风险模型显示，校正混杂变量后，N-末端脑钠肽前体[风险比（HR）=1.002；P<0.001]和GFR（HR=0.972；P<0.005）是死亡率的显著预测因素。Kaplan-Meier分析表明，N-末端脑钠肽前体值从最低三分位数到最高三分位数，生存率逐渐降低（对数秩=28.7；P<0.001），GFR值从高到低，生存率也逐渐降低（对数秩=5.63；P<0.01）。此外，通过威布尔模型进行的参数生存分析表明，GFR≥60 ml/分钟的患者经N-末端脑钠肽前体值校正后的估计生存率高于GFR<60 ml/分钟的患者（P<0.001）。
N-末端脑钠肽前体升高及肾功能下降是CHF患者死亡的独立危险因素，而贫血不是。
