Mielniczuk Lisa M, Chandy George, Stewart Duncan, Contreras-Dominguez Vladamir, Haddad Haissam, Pugliese C, Davies Ross A
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Congest Heart Fail. 2012 May-Jun;18(3):151-7. doi: 10.1111/j.1751-7133.2011.00275.x. Epub 2012 Jan 23.
Increased central venous pressures have been associated with the development of worsening renal function (WRF), an important marker of prognosis. We sought to determine the incidence and prognostic significance of WRF in pulmonary hypertension patients (PH) with isolated right HF. A prospective study of PH clinic patients admitted to hospital for right HF. WRF was defined as a rise in creatinine of 26 μmol/L (0.3 mg/dL) within the first 48 hours of admission. A total of 32 patients were enrolled in this study, 67% of patients had moderate-severe chronic kidney disease with an eGFR ≤ 60 mL/min and 34% (n=11) developed WRF during their admission. The mean right atrial pressure was higher in patients with WRF (19 ± 7 mm Hg vs 12 ± 6 mm Hg, P=.05). A total of 36% of patients with WRF died in hospital compared to 5% in the group that did not develop WRF (OR for hospital death 13.3 ± 16, P=.03). The combined endpoint of death or readmission at 6 months was 45% in the WRF group and 43% in the group without WRF (P=.89). Significant renal dysfunction is common in patients with PH and an acute decline in renal function is an important marker of in hospital death and short term mortality in right heart failure.
中心静脉压升高与肾功能恶化（WRF）的发生有关，WRF是一个重要的预后指标。我们试图确定孤立性右心衰竭的肺动脉高压患者（PH）中WRF的发生率及其预后意义。对因右心衰竭入院的PH门诊患者进行了一项前瞻性研究。WRF定义为入院后48小时内肌酐升高26μmol/L（0.3mg/dL）。本研究共纳入32例患者，67%的患者患有中度至重度慢性肾脏病，估算肾小球滤过率（eGFR）≤60mL/（min·1.73m²），34%（n = 11）的患者在住院期间发生了WRF。发生WRF的患者平均右心房压更高（19±7mmHg对12±6mmHg，P = 0.05）。发生WRF的患者中有36%在医院死亡，而未发生WRF的组中这一比例为5%（住院死亡的比值比为13.3±16，P = 0.03）。WRF组6个月时死亡或再入院的复合终点发生率为45%，未发生WRF的组为43%（P = 0.89）。PH患者中严重肾功能不全很常见，肾功能急性下降是右心衰竭患者住院死亡和短期死亡率的重要指标。
