Servicio de Cardiologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Rev Esp Cardiol. 2010 Mar;63(3):294-302. doi: 10.1016/s1885-5857(10)70062-1.
Acute decompensated heart failure (ADHF) is a common cause of hospital admission and is associated with an increased risk of worsening renal function (WRF). The aims of this study were to investigate the incidence and predictors of WRF in patients admitted for ADHF and to assess the prognostic significance of WRF at 1 year.
A retrospective analysis of data on 200 consecutive patients admitted with ADHF was carried out. By definition, WRF occurred when the serum creatinine level increased during hospitalization by 0.3 mg/dL and by > or =25% from admission.
Overall, 23% of patients developed WRF. On multivariate analysis, age >80 years (odds ratio [OR]=2.72; 95% confidence interval [CI], 1.86-3.42), admission glomerular filtration rate <60 mL/min per 1.73 m2 (OR=2.05; 95% CI, 1.53-2.27) and admission systolic pressure <90 mmHg (OR=1.61, 95% CI, 1.17-3.22) were independently associated with WRF. The rate of mortality or readmission for heart failure (HF) at 1 year was higher in the WRF group (P< .01 by log-rank test). The median hospital stay was 9 days for patients with WRF and 4 days for those without (P< .05). On multivariate analysis, WRF remained independently associated with mortality or HF rehospitalization (hazard ratio=1.65; 95% CI, 1.12-2.67; P=.003).
In patients admitted for ADHF, WRF was a common complication and was associated with a longer hospital stay and an increased risk of mortality or HF hospitalization. Clinical characteristics at admission can help identify patients at an increased risk of WRF.
急性失代偿性心力衰竭（ADHF）是住院的常见原因，并与肾功能恶化（WRF）的风险增加相关。本研究的目的是调查因 ADHF 住院的患者中 WRF 的发生率和预测因素，并评估 WRF 在 1 年时的预后意义。
对 200 例连续因 ADHF 入院的患者进行回顾性数据分析。根据定义，当住院期间血清肌酐水平升高 0.3mg/dL 且较入院时升高≥25%时，发生 WRF。
总体而言，23%的患者发生了 WRF。多变量分析显示，年龄>80 岁（比值比[OR]=2.72；95%置信区间[CI]，1.86-3.42）、入院肾小球滤过率<60mL/min/1.73m2（OR=2.05；95%CI，1.53-2.27）和入院收缩压<90mmHg（OR=1.61，95%CI，1.17-3.22）与 WRF 独立相关。WRF 组 1 年死亡率或因心力衰竭（HF）再次入院的发生率更高（log-rank 检验，P<.01）。WRF 组的中位住院时间为 9 天，无 WRF 组为 4 天（P<.05）。多变量分析显示，WRF 与死亡率或 HF 再入院仍独立相关（风险比=1.65；95%CI，1.12-2.67；P=.003）。
在因 ADHF 住院的患者中，WRF 是一种常见的并发症，与住院时间延长和死亡率或 HF 住院风险增加相关。入院时的临床特征有助于识别发生 WRF 风险增加的患者。
