Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
Am J Cardiol. 2010 Dec 15;106(12):1763-9. doi: 10.1016/j.amjcard.2010.07.050. Epub 2010 Nov 4.
Worsening renal function (RF) and improved RF during the treatment of decompensated heart failure have traditionally been thought of as hemodynamically distinct events. We hypothesized that if the pulmonary artery catheter-derived measures are relevant in the evaluation of cardiorenal interactions, the comparison of patients with improved versus worsening RF should highlight any important hemodynamic differences. All subjects in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial limited data set with admission and discharge creatinine values available were included (n = 401). No differences were found in the baseline, final, or change in pulmonary artery catheter-derived hemodynamic variables, inotrope and intravenous vasodilator use, or survival between patients with improved versus worsening RF (p = NS for all). Both groups were equally likely to be in the bottom quartile of cardiac index (p = 0.32), have a 25% improvement in cardiac index (p = 0.97), or have any worsening in cardiac index (p = 0.90). When patients with any significant change in renal function (positive or negative) were compared to those with stable renal function, strong associations between variables such as a reduced cardiac index (odds ratio 2.2, p = 0.02), increased intravenous inotrope and vasodilator use (odds ratio 2.9, p <0.001), and worsened all-cause mortality (hazard ratio 1.8, p = 0.01) became apparent. In contrast to traditionally held views, the patients with improved RF and those with worsening RF had similar hemodynamic parameters and outcomes. Combining these groups identified a hemodynamically compromised population with significantly worse survival than patients with stable renal function. In conclusion, the changes in renal function, regardless of the direction, likely identify a population with an advanced disease state and a poor prognosis.
肾功能恶化（RF）和失代偿性心力衰竭治疗期间 RF 改善传统上被认为是血流动力学上不同的事件。我们假设，如果肺动脉导管衍生的测量在评估心肾相互作用中是相关的，那么比较 RF 改善和恶化的患者应该突出任何重要的血流动力学差异。入选了充血性心力衰竭和肺动脉导管有效性评估研究（Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial）有限数据集且有入院和出院肌酐值的所有患者（n = 401）。在基线、终末或肺动脉导管衍生血流动力学变量的变化、正性肌力药和静脉血管扩张剂的使用或生存率方面，RF 改善和恶化的患者之间没有差异（p = NS 均）。两组患者心指数处于最低四分位数的可能性相似（p = 0.32），心指数改善 25%的可能性相同（p = 0.97），心指数任何恶化的可能性也相同（p = 0.90）。当将肾功能有任何显著变化（阳性或阴性）的患者与肾功能稳定的患者进行比较时，变量之间存在很强的关联，如心指数降低（比值比 2.2，p = 0.02）、静脉正性肌力药和血管扩张剂使用增加（比值比 2.9，p <0.001）以及全因死亡率恶化（风险比 1.8，p = 0.01）。与传统观点相反，RF 改善的患者和 RF 恶化的患者具有相似的血流动力学参数和结局。将这两组患者合并可识别出一组血流动力学受损的患者，其生存率明显差于肾功能稳定的患者。总之，无论方向如何，肾功能的变化可能会识别出一个疾病状态较严重且预后较差的人群。
