Krishnamoorthy Arun, Greiner Melissa A, Sharma Puza P, DeVore Adam D, Johnson Katherine Waltman, Fonarow Gregg C, Curtis Lesley H, Hernandez Adrian F
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Am Heart J. 2014 Dec;168(6):891-900. doi: 10.1016/j.ahj.2014.08.016. Epub 2014 Sep 16.
Transient and persistent worsening renal function (WRF) may be associated with different risks during hospitalization for acute heart failure. We compared outcomes of patients hospitalized for acute heart failure with transient, persistent, or no WRF.
We identified patients 65 years or older hospitalized with acute heart failure from a clinical registry linked to Medicare claims data. We defined WRF as an increase in serum creatinine of ≥ 0.3 mg/dL after admission. We further classified patients with WRF by the difference between admission and last recorded serum creatinine levels into transient WRF (< 0.3 mg/dL) or persistent WRF (≥ 0.3 mg/dL). We examined unadjusted rates and adjusted associations between 90-day outcomes and WRF status.
Among 27,309 patients, 18,568 (68.0%) had no WRF, 3,205 (11.7%) had transient WRF, and 5,536 (20.3%) had persistent WRF. Patients with WRF had higher observed rates of 90-day postdischarge all-cause readmission and 90-day postadmission mortality (P < .001). After multivariable adjustment, transient WRF (hazard ratio [HR] 1.19, 99% CI 1.05-1.35) and persistent WRF (HR 1.73, 99% CI 1.57-1.91) were associated with higher risks of 90-day postadmission mortality (P < .001 for both). Compared with transient WRF, persistent WRF was associated with a higher risk of 90-day postadmission mortality (HR 1.46, 99% CI 1.28-1.66, P < .001).
Transient and persistent WRF during hospitalization for acute heart failure were associated with higher adjusted risks for 90-day all-cause postadmission mortality. Patients with persistent WRF had worse outcomes.
在急性心力衰竭住院期间，短暂性和持续性肾功能恶化（WRF）可能与不同风险相关。我们比较了因急性心力衰竭住院且伴有短暂性、持续性或无WRF的患者的预后情况。
我们从与医疗保险理赔数据相关的临床登记中识别出65岁及以上因急性心力衰竭住院的患者。我们将WRF定义为入院后血清肌酐升高≥0.3mg/dL。我们根据入院时和最后记录的血清肌酐水平之间的差异，将WRF患者进一步分类为短暂性WRF（<0.3mg/dL）或持续性WRF（≥0.3mg/dL）。我们检查了90天预后与WRF状态之间的未调整率和调整后的关联。
在27309例患者中，18568例（68.0%）无WRF，3205例（11.7%）有短暂性WRF，5536例（20.3%）有持续性WRF。有WRF的患者90天出院后全因再入院率和90天入院后死亡率的观察率更高（P<.001）。多变量调整后，短暂性WRF（风险比[HR]1.19，99%CI 1.05-1.35）和持续性WRF（HR 1.73，99%CI 1.57-1.91）与90天入院后死亡率的较高风险相关（两者P<.001）。与短暂性WRF相比，持续性WRF与90天入院后死亡率的较高风险相关（HR 1.46，99%CI 1.28-1.66，P<.001）。
急性心力衰竭住院期间的短暂性和持续性WRF与90天入院后全因死亡率的较高调整风险相关。持续性WRF的患者预后更差。
