Shah H R, Singh N P, Aggarwal N P, Singhania D, Kumar A
DNB Resident, Dept. of Medicine.
Director, Meedicine Allied Specialities.
J Assoc Physicians India. 2016 Dec;64(12):41-46.
Over recent years, the field of medicine has been challenged by the twin epidemic of heart failure and renal insufficiency. The coexistence of the two problems in the same patient, referred to as cardiorenal syndrome (CRS), is defined as 'disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The mechanisms underlying this interaction are complex and multifactorial in nature.
Identify and classify patients admitted with cardiorenal syndrome into various subtypes and assess clinical outcome at discharge and at three months.
Ours was a longitudinal study of 50 patients admitted in ICU with CRS. They were classified as per RONCO classification (2008) into various subtypes. Outcomes was addressed as favourable for patients stable at discharge and at 3 months follow up, whereas outcome was termed non-favourable for patients who expired or initiated on hemodialysis.
Of 50 patients, two-third patients were males (66%), with mean age of males and females being 64.18 years and 64.64 years respectively. Majority of the patients had Type-1 CRS (46%) followed by twenty two percent Type-2, twenty six percent type-4 and six percent Type-5. There were no patients with type-3 CRS. At the end of the study, 24 (48%) patients were stable, 12 (24%) required dialysis and 14 (28%) patients had expired. The total non-favourable outcomes (dialysis / death) were higher with subtypes CRS-4 (n-11, 22%) and CRS-1 (n-8, 16%). Anemia, raised serum creatinine, low eGFR values, low ejection fraction were significant predictors of non-favourable outcome in our study.
CRS occurs in all age groups, more commonly in elderlies with a male preponderance. Prevalence of CRS-1 was higher followed by CRS-4. Prognosis was unfavourable in CRS-1, CRS-4 and CRS-5. Sepsis was predominant cause of death in patients with CRS-5 with hundred percent mortality during hospital stay. Risk factors like pre-existing renal impairment, anemia, reduced e GFR and low ejection fraction were significantly associated with worse outcomes. There is need for large scale population / community based studies to chart the prevalence of cardiorenal subtypes and prognosticate each individually.
近年来，医学领域受到心力衰竭和肾功能不全这两大流行病的挑战。同一患者中这两个问题并存，即心肾综合征（CRS），被定义为“心脏和肾脏的紊乱，其中一个器官的急性或慢性功能障碍可能导致另一个器官的急性或慢性功能障碍。这种相互作用的机制本质上是复杂且多因素的。
识别并将因心肾综合征入院的患者分类为不同亚型，并评估出院时和三个月时的临床结局。
我们对50例因CRS入住重症监护病房的患者进行了一项纵向研究。根据RONCO分类（2008年）将他们分为不同亚型。对于出院时和3个月随访时病情稳定的患者，结局被视为良好，而对于死亡或开始进行血液透析的患者，结局被称为不良。
50例患者中，三分之二为男性（66%），男性和女性的平均年龄分别为64.18岁和64.64岁。大多数患者为1型CRS（46%），其次是22%的2型、26%的4型和6%的5型。没有3型CRS患者。在研究结束时，24例（48%）患者病情稳定，12例（24%）需要透析，14例（28%）患者死亡。CRS-4（n = 11，22%）和CRS-1（n = 8，16%）亚型的总不良结局（透析/死亡）更高。贫血、血清肌酐升高、估算肾小球滤过率（eGFR）值低、射血分数低是我们研究中不良结局的重要预测因素。
CRS发生于所有年龄组，更常见于老年人，男性居多。CRS-1的患病率最高，其次是CRS-4。CRS-1、CRS-4和CRS-5的预后不良。脓毒症是CRS-5患者死亡的主要原因，住院期间死亡率为100%。既往存在的肾功能损害、贫血、eGFR降低和射血分数低等危险因素与更差的结局显著相关。需要进行大规模的基于人群/社区的研究，以绘制心肾亚型的患病率并分别预测每种亚型的预后。
