Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Cardiorenal Med. 2014 Aug;4(2):88-94. doi: 10.1159/000362566. Epub 2014 May 6.
Many patients admitted to a Department of Internal Medicine have different degrees of heart and kidney dysfunction. Mortality, morbidity and cost of care greatly increase when cardiac and renal diseases coexist.
A retrospective cohort study was conducted on 1,087 patients admitted from December 2009 to December 2012 to evaluate the prevalence of the cardiorenal syndrome (CRS) and clinical features.
Out of 1,087 patients discharged from our unit during the study period, 190 (17.5%) were diagnosed as having CRS and classified into five types. CRS was more common in males (68.9%). CRS type 1 was associated with higher age (79.9 ± 8.9 years) and accounted for 61.5% of all deaths (p < 0.001), representing a risk factor for mortality (OR 4.23, 95% CI 1.8-10). Congestive heart failure was significantly different among the five CRS types (p < 0.0001) with a greater frequency in type 1 patients. Infectious diseases were more frequent in CRS types 1, 3 and 5 (p < 0.05). Pneumonia presented a statistically higher frequency in CRS types 1 and 5 compared to other classes (p < 0.01), and community-acquired infections were statistically more frequent in CRS types 1 and 5 (p < 0.05). The distribution of community-acquired pneumonia was different among the classes (p < 0.01) with a higher frequency in CRS types 1, 3 and 5.
CRS is a condition that is more frequently observed in the clinical practice. The identification of predisposing trigger factors, such as infectious diseases, particularly in the elderly, plays a key role in reducing morbidity and mortality. An early recognition can be useful to optimize therapy, encourage a multidisciplinary approach and prevent complications.
许多内科住院患者都有不同程度的心肾功能障碍。当心脏和肾脏疾病同时存在时，死亡率、发病率和医疗费用都会大幅增加。
我们对 2009 年 12 月至 2012 年 12 月期间从我们科室出院的 1087 名患者进行了回顾性队列研究，以评估心脏肾综合征（CRS）的患病率和临床特征。
在研究期间，从我们科室出院的 1087 名患者中，有 190 名（17.5%）被诊断患有 CRS，并分为五型。CRS 更常见于男性（68.9%）。CRS 型 1 与较高的年龄相关（79.9±8.9 岁），占所有死亡人数的 61.5%（p<0.001），是死亡的危险因素（OR 4.23，95%CI 1.8-10）。五种 CRS 类型之间心力衰竭的发生率存在显著差异（p<0.0001），其中 1 型患者的发生率最高。CRS 型 1、3 和 5 中感染性疾病的发生率较高（p<0.05）。与其他类型相比，1 型和 5 型 CRS 患者肺炎的发生率更高（p<0.01），社区获得性感染在 1 型和 5 型 CRS 中更常见（p<0.05）。社区获得性肺炎在各类型之间的分布不同（p<0.01），1 型、3 型和 5 型的发生率更高。
CRS 是一种在临床实践中更常见的情况。识别易患诱因，如感染性疾病，特别是在老年人中，对于降低发病率和死亡率至关重要。早期识别可以有助于优化治疗、鼓励多学科治疗并预防并发症。
