National Research Council-Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
J Am Soc Nephrol. 2013 Mar;24(4):639-46. doi: 10.1681/ASN.2012100990. Epub 2013 Feb 28.
Pulmonary congestion is highly prevalent and often asymptomatic among patients with ESRD treated with hemodialysis, but whether its presence predicts clinical outcomes is unknown. Here, we tested the prognostic value of extravascular lung water measured by a simple, well validated ultrasound B-lines score (BL-US) in a multicenter study that enrolled 392 hemodialysis patients. We detected moderate-to-severe lung congestion in 45% and very severe congestion in 14% of the patients. Among those patients with moderate-to-severe lung congestion, 71% were asymptomatic or presented slight symptoms of heart failure. Compared with those patients having mild or no congestion, patients with very severe congestion had a 4.2-fold risk of death (HR=4.20, 95% CI=2.45-7.23) and a 3.2-fold risk of cardiac events (HR=3.20, 95% CI=1.75-5.88) adjusted for NYHA class and other risk factors. Including the degree of pulmonary congestion in the model significantly improved the risk reclassification for cardiac events by 10% (P<0.015). In summary, lung ultrasound can detect asymptomatic pulmonary congestion in hemodialysis patients, and the resulting BL-US score is a strong, independent predictor of death and cardiac events in this population.
肺淤血在接受血液透析治疗的 ESRD 患者中非常普遍，且常常无症状，但目前尚不清楚其存在是否可预测临床结局。在这里，我们在一项多中心研究中检验了通过简单且经过充分验证的超声 B 线评分（BL-US）测量的肺血管外水的预后价值，该研究纳入了 392 名血液透析患者。我们在 45%的患者中检测到中度至重度肺淤血，在 14%的患者中检测到非常严重的淤血。在那些有中度至重度肺淤血的患者中，71%的患者无症状或仅有轻微的心衰症状。与那些仅有轻度或无淤血的患者相比，非常严重淤血的患者死亡风险增加 4.2 倍（HR=4.20，95%CI=2.45-7.23），心脏事件风险增加 3.2 倍（HR=3.20，95%CI=1.75-5.88），校正 NYHA 分级和其他危险因素后。在模型中纳入肺淤血程度可使心脏事件的风险再分类显著提高 10%（P<0.015）。总之，肺部超声可检测血液透析患者无症状性肺淤血，由此产生的 BL-US 评分是该人群死亡和心脏事件的强有力独立预测因子。
