急性心力衰竭患者的生物电阻抗矢量分析与临床结局
Bioelectrical impedance vector analysis and clinical outcomes in patients with acute heart failure.
作者信息
Núñez Julio, Mascarell Beatriz, Stubbe Hans, Ventura Silvia, Bonanad Clara, Bodí Vicent, Núñez Eduardo, Miñana Gema, Fácila Lorenzo, Bayés-Genis Antonio, Chorro Francisco J, Sanchis Juan
机构信息
aServicio de Cardiología, Hospital Clínico Universitario bServicio de Cardiología, Hospital de Manises cServicio de Cardiología, Hospital General Universitario de Valencia dServicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
出版信息
J Cardiovasc Med (Hagerstown). 2016 Apr;17(4):283-90. doi: 10.2459/JCM.0000000000000208.
AIMS
Fluid overload is a hallmark in acute heart failure (AHF). Bioelectrical impedance vector analysis (BIVA) has emerged as a noninvasive method for quantifying patients' hydration. We aimed to evaluate the effect of BIVA hydration status (BHS) measured before discharge on mortality and rehospitalization for AHF.
METHODS
We included 369 consecutive patients discharged from the cardiology department from a third-level hospital with a diagnosis of AHF. On the basis of BHS, patients were grouped into three categories: hyper-hydration (>74.3%), normo-hydration (72.7-74.3%) and dehydration (<72.7%). Appropriate survival techniques were used to evaluate the association between BHS and the risk of death and readmission for AHF.
RESULTS
At a median follow-up of 12 months (interquartile range, IQR: 5-19), 80 (21.7%) deaths and 93 (25.2%) readmissions for AHF were registered. The mortality and readmission rates for the BHS categories were hyper-hydration (3.28 and 3.83 per 10 persons-years); normo-hydration (1.43 and 2.68 per 10 persons-years); and dehydration (2.24 and 2.53 per 10 persons-years) (P < 0.05 for all comparisons). In an adjusted analysis, BHS displayed a significant association with mortality (P = 0.004), with a higher mortality risk in those with hyperhydration. Likewise, BHS showed to linearly predict AHF-readmission risk [hazard ratio 1.06 (1.03-1.10); P = 0.001 per increase in 1%].
CONCLUSION
In patients admitted with AHF, BHS assessed before discharge was independently associated with the risk of death and AHF-readmission.
目的
液体超负荷是急性心力衰竭（AHF）的一个标志。生物电阻抗矢量分析（BIVA）已成为一种用于量化患者水合状态的非侵入性方法。我们旨在评估出院前测量的BIVA水合状态（BHS）对AHF患者死亡率和再住院率的影响。
方法
我们纳入了一家三级医院心内科连续出院的369例诊断为AHF的患者。根据BHS，患者被分为三类：水合过度（>74.3%）、水合正常（72.7 - 74.3%）和脱水（<72.7%）。采用适当的生存技术评估BHS与AHF死亡风险和再入院风险之间的关联。
结果
在中位随访12个月（四分位间距，IQR：5 - 19）时，记录到80例（21.7%）死亡和93例（25.2%）因AHF再次入院。BHS各分类的死亡率和再入院率分别为：水合过度（每10人年3.28例和3.83例）；水合正常（每10人年1.43例和2.68例）；脱水（每10人年2.24例和2.53例）（所有比较P < 0.05）。在调整分析中，BHS与死亡率显示出显著关联（P = 0.004），水合过度者的死亡风险更高。同样，BHS显示可线性预测AHF再入院风险[风险比1.06（1.03 - 1.10）；每增加1%，P = 0.001]。
结论
在因AHF入院的患者中，出院前评估的BHS与死亡风险和AHF再入院独立相关。
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