Dupont Matthias, Shrestha Kevin, Singh Dhssraj, Finucan Michael, Tang W H Wilson
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Congest Heart Fail. 2013 Jul-Aug;19(4):E17-21. doi: 10.1111/chf.12015. Epub 2013 Jan 7.
Worsening renal function (WRF) during treatment of acute decompensated heart failure (ADHF) is generally associated with adverse outcomes. An increase ≥0.3 mg/dL in creatinine level is widely used as the definition of WRF. The authors sought to determine the level of agreement between WRF based on changes in creatinine and changes in cystatin C (CysC) by analyzing data from 121 ADHF patients with available admission and day 3 creatinine and CysC levels. Admission creatinine and CysC levels were 1.39 (0.98-2.11) mg/dL and 1.95 (1.42-2.69) mg/L, respectively, and correlated well (r=0.81). On average, creatinine (-0.04±0.40 mg/dL) and CysC (0.001±0.34 mg/L) changed minimally from admission to day 3. Although the correlation between both markers on day 3 was still good (r=0.79), the correlation between changes therein was only modest (r=0.43). From the 14 and 15 patients who had WRF based on a ≥0.3 mg/dL increase in creatinine and ≥0.3 mg/L increase in CysC, respectively, only four (about 30%) met both definitions. These observations, together with recent insights in the inconsistencies of creatinine-defined concept of worsening renal function and outcomes, raises the need to research more reliable measures of renal function during treatment of ADHF.
急性失代偿性心力衰竭（ADHF）治疗期间肾功能恶化（WRF）通常与不良预后相关。肌酐水平升高≥0.3mg/dL被广泛用作WRF的定义。作者通过分析121例有入院时及第3天肌酐和胱抑素C（CysC）水平数据的ADHF患者的数据，试图确定基于肌酐变化的WRF与CysC变化之间的一致性水平。入院时肌酐和CysC水平分别为1.39（0.98 - 2.11）mg/dL和1.95（1.42 - 2.69）mg/L，且相关性良好（r = 0.81）。平均而言，从入院到第3天，肌酐（-0.04±0.40mg/dL）和CysC（0.001±0.34mg/L）变化极小。尽管第3天时两种标志物之间的相关性仍然良好（r = 0.79），但它们变化之间的相关性仅为中等（r = 0.43）。分别有14例和15例患者基于肌酐升高≥0.3mg/dL和CysC升高≥0.3mg/L出现WRF，其中只有4例（约30%）符合两种定义。这些观察结果，连同最近对肌酐定义的肾功能恶化概念与预后不一致性的见解，增加了在ADHF治疗期间研究更可靠肾功能测量方法的必要性。
