Caetano Francisca, Barra Sérgio, Faustino Ana, Botelho Ana, Mota Paula, Costa Marco, Leitão Marques António
Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Hospital Geral, Coimbra, Portugal.
Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Hospital Geral, Coimbra, Portugal.
Rev Port Cardiol. 2014 Mar;33(3):139-46. doi: 10.1016/j.repc.2013.09.010. Epub 2014 Mar 15.
Worsening renal function has an unquestionably negative impact on prognosis in patients with acute heart failure (HF). In Portugal there is little information about the importance of this entity in HF patients admitted to hospital. The objective of this work was to assess the prevalence of cardiorenal syndrome and to identify its key predictors and consequences in patients admitted for acute HF.
This was a retrospective study of 155 patients admitted for acute HF. Cardiorenal syndrome was defined as an increase in serum creatinine of ≥26.5 μmol/l. Clinical, laboratory and echocardiographic parameters were analyzed and compared. Mortality was assessed at 30 and 90 days.
Cardiorenal syndrome occurred in 46 patients (29.7%), 5.4 ± 4.4 days after admission; 66.7% (n=24) did not recover baseline creatinine levels. The factors associated with cardiorenal syndrome were older age, chronic renal failure, moderate to severe mitral regurgitation, higher admission blood urea nitrogen, creatinine and troponin I, and lower glomerular filtration rate. Patients who developed cardiorenal syndrome had longer hospital stay, were treated with higher daily doses of intravenous furosemide, and more often required inotropic support and renal replacement therapy. They had higher in-hospital and 30-day mortality, and multivariate analysis identified cardiorenal syndrome as an independent predictor of in-hospital mortality.
Renal dysfunction is common in acute HF patients, with a negative impact on prognosis, which highlights the importance of preventing kidney damage through the use of new therapeutic strategies and identification of novel biomarkers.
肾功能恶化对急性心力衰竭（HF）患者的预后有着毋庸置疑的负面影响。在葡萄牙，关于这一情况在住院HF患者中的重要性的信息较少。本研究的目的是评估心肾综合征的患病率，并确定其在急性HF住院患者中的关键预测因素及后果。
这是一项对155例急性HF住院患者的回顾性研究。心肾综合征定义为血清肌酐升高≥26.5μmol/l。对临床、实验室及超声心动图参数进行分析和比较。评估30天和90天的死亡率。
46例患者（29.7%）发生心肾综合征，于入院后5.4±4.4天出现；66.7%（n=24）未恢复至基线肌酐水平。与心肾综合征相关的因素包括老年、慢性肾衰竭、中度至重度二尖瓣反流、入院时较高的血尿素氮、肌酐及肌钙蛋白I水平，以及较低的肾小球滤过率。发生心肾综合征的患者住院时间更长，每日静脉注射呋塞米剂量更高，更常需要使用血管活性药物支持及肾脏替代治疗。他们的院内死亡率和30天死亡率更高，多因素分析确定心肾综合征是院内死亡的独立预测因素。
肾功能不全在急性HF患者中很常见，对预后有负面影响，这凸显了通过采用新的治疗策略及识别新型生物标志物来预防肾脏损害的重要性。
