Wattad Malak, Darawsha Wisam, Solomonica Amir, Hijazi Maher, Kaplan Marielle, Makhoul Badira F, Abassi Zaid A, Azzam Zaher S, Aronson Doron
Department of Cardiology, Rambam Medical Center, Haifa, Israel.
Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel.
Am J Cardiol. 2015 Apr 1;115(7):932-7. doi: 10.1016/j.amjcard.2015.01.019. Epub 2015 Jan 15.
Worsening renal function (WRF) and congestion are inextricably related pathophysiologically, suggesting that WRF occurring in conjunction with persistent congestion would be associated with worse clinical outcome. We studied the interdependence between WRF and persistent congestion in 762 patients with acute decompensated heart failure (HF). WRF was defined as ≥0.3 mg/dl increase in serum creatinine above baseline at any time during hospitalization and persistent congestion as ≥1 sign of congestion at discharge. The primary end point was all-cause mortality with mean follow-up of 15 ± 9 months. Readmission for HF was a secondary end point. Persistent congestion was more common in patients with WRF than in patients with stable renal function (51.0% vs 26.6%, p <0.0001). Both persistent congestion and persistent WRF were significantly associated with mortality (both p <0.0001). There was a strong interaction (p = 0.003) between persistent WRF and congestion, such that the increased risk for mortality occurred predominantly with both WRF and persistent congestion. The adjusted hazard ratio for mortality in patients with persistent congestion as compared with those without was 4.16 (95% confidence interval [CI] 2.20 to 7.86) in patients with WRF and 1.50 (95% CI 1.16 to 1.93) in patients without WRF. In conclusion, persisted congestion is frequently associated with WRF. We have identified a substantial interaction between persistent congestion and WRF such that congestion portends increased mortality particularly when associated with WRF.
肾功能恶化（WRF）与充血在病理生理上有着千丝万缕的联系，这表明与持续性充血同时出现的WRF会导致更差的临床结局。我们研究了762例急性失代偿性心力衰竭（HF）患者中WRF与持续性充血之间的相互关系。WRF定义为住院期间任何时间血清肌酐较基线水平升高≥0.3mg/dl，持续性充血定义为出院时存在≥1项充血体征。主要终点是全因死亡率，平均随访时间为15±9个月。因HF再次入院是次要终点。与肾功能稳定的患者相比，WRF患者中持续性充血更为常见（51.0%对26.6%，p<0.0001）。持续性充血和持续性WRF均与死亡率显著相关（均p<0.0001）。持续性WRF与充血之间存在强烈的相互作用（p = 0.003），因此死亡率增加主要发生在WRF和持续性充血同时存在的情况下。与无持续性充血的患者相比，有持续性充血的患者的校正死亡风险比在WRF患者中为4.16（95%置信区间[CI]2.20至7.86），在无WRF的患者中为1.50（95%CI 1.16至1.93）。总之，持续性充血常与WRF相关。我们发现持续性充血与WRF之间存在显著的相互作用，即充血预示着死亡率增加，尤其是与WRF相关时。
