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床边下腔静脉直径和平均动脉压可预测住院心力衰竭患者的长期死亡率:36个月随访

Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up.

作者信息

Torres Daniele, Cuttitta Francesco, Paterna Salvatore, Garofano Alessandro, Conti Giosafat, Pinto Antonio, Parrinello Gaspare

机构信息

Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia.

Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia.

出版信息

Eur J Intern Med. 2016 Mar;28:80-4. doi: 10.1016/j.ejim.2015.11.029. Epub 2015 Dec 30.

Abstract

BACKGROUND

In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF.

METHODS

One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization.

RESULTS

At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (HR 1.06, p=0.0057; HR 0.97, p=0.0218; respectively). Study population was subdivided according to median values of IVC diameter (23 mm) and MAP (93.3 mm Hg). The Kaplan–Meier curve showed that HF patients with both IVC ≥ 23 mm and MAP b93.3 mm Hg on admission had reduced probability of survival free from all-cause death (log rank p = 0.0070 and log rank p = 0.0028, respectively).

CONCLUSIONS

In patients hospitalized for acute HF, IVC diameter, measured by hand-carried ultrasound (HCU), and MAP detected on admission are strong predictors of long-term all-cause mortality. The data suggest the need for a careful clinical-therapeutic surveillance on these patients during the post-discharge period. IVC diameter and MAP can be utilized as parameters to stratify prognosis on admission and to be supervised during follow-up.

摘要

背景

在心力衰竭(HF)出院患者中,多种情况可导致预后恶化。我们将研究入院时存在的这些因素是否会影响因急性HF住院患者的长期死亡率。

方法

招募了123例因急性HF连续住院的患者(平均年龄74.8岁;57%为女性),并在住院后随访36个月。

结果

在多变量Cox模型中,入院时床边记录的仅下腔静脉(IVC)直径和平均动脉压(MAP),在校正所有混杂因素后,是与长期全因死亡率较高风险显著相关的唯一因素(HR分别为1.06,p = 0.0057;HR为0.97,p = 0.0218)。根据IVC直径(23 mm)和MAP(93.3 mmHg)的中位数对研究人群进行细分。Kaplan–Meier曲线显示,入院时IVC≥23 mm且MAP≤93.3 mmHg的HF患者无全因死亡的生存概率降低(对数秩检验p分别为0.0070和0.0028)。

结论

在因急性HF住院的患者中,通过手持式超声(HCU)测量的IVC直径和入院时检测到的MAP是长期全因死亡率的有力预测指标。数据表明在出院后期间需要对这些患者进行仔细的临床治疗监测。IVC直径和MAP可作为入院时分层预后及随访期间监测的参数。

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