Okabe Toshitaka, Yakushiji Tadayuki, Kido Takehiko, Oyama Yuji, Igawa Wataru, Ono Morio, Ebara Seitaro, Yamashita Kennosuke, Yamamoto Myong Hwa, Saito Shigeo, Amemiya Kisaki, Isomura Naoei, Araki Hiroshi, Ochiai Masahiko
Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
Int J Cardiol. 2017 Mar 1;230:47-52. doi: 10.1016/j.ijcard.2016.12.101. Epub 2016 Dec 21.
Recently several studies showed that worsening renal function (WRF) during hospitalization might be a strong independent predictor of poor prognosis in decompensated heart failure (HF) patients. However, these studies had a relatively short follow-up duration and their data were limited to in-hospital outcomes. Our purpose was to assess the relationship between WRF and long-term cardiovascular mortality in HF patients.
We enrolled decompensated HF patients who were admitted to our hospital between April 2010 and March 2015. WRF was defined as a relative increase in serum creatinine of at least 25% or an absolute increase in serum creatinine ≥0.3mg/dL from the baseline. We assessed the cardiovascular mortality and all-cause mortality in HF patients with WRF (WRF group) and without WRF (no WRF group).
Among 301 patients enrolled, WRF developed in 118 patients (39.2%). During a median follow-up period of 537days [interquartile range, 304.3 to 1025.8days], cardiovascular mortality and all-cause mortality were significantly higher in the WRF group than in the no WRF group (23.2% vs. 6.1%, P<0.001; 30.3% vs. 14.7%, P<0.001, respectively). In the multivariate Cox proportional hazards model, age and serum B-type natriuretic peptide (BNP) level were associated with both cardiovascular death and all-cause death. However, WRF was not the independent predictor of cardiovascular death (P=0.19) nor all-cause death (P=0.57).
WRF was associated with cardiovascular death in patients with HF. Although not an independent predictor, WRF might be one of useful markers to identify patients who should be followed carefully after discharge.
最近的几项研究表明，住院期间肾功能恶化（WRF）可能是失代偿性心力衰竭（HF）患者预后不良的一个强有力的独立预测因素。然而，这些研究的随访时间相对较短，且其数据仅限于住院结局。我们的目的是评估HF患者中WRF与长期心血管死亡率之间的关系。
我们纳入了2010年4月至2015年3月期间入住我院的失代偿性HF患者。WRF定义为血清肌酐较基线水平相对升高至少25%或血清肌酐绝对升高≥0.3mg/dL。我们评估了发生WRF的HF患者（WRF组）和未发生WRF的HF患者（无WRF组）的心血管死亡率和全因死亡率。
在纳入的301例患者中，118例（39.2%）发生了WRF。在中位随访期537天[四分位间距，304.3至1025.8天]内，WRF组的心血管死亡率和全因死亡率显著高于无WRF组（分别为23.2%对6.1%，P<0.001；30.3%对14.7%，P<0.001）。在多变量Cox比例风险模型中，年龄和血清B型利钠肽（BNP）水平与心血管死亡和全因死亡均相关。然而，WRF不是心血管死亡（P=0.19）或全因死亡（P=0.57）的独立预测因素。
WRF与HF患者的心血管死亡相关。虽然不是独立预测因素，但WRF可能是识别出院后应密切随访患者的有用标志物之一。
