Casado Jesús, Sánchez Marta, Garcés Vanesa, Manzano Luis, Cerqueiro José Manuel, Epelde Francisco, García-Escrivá David, Pérez-Silvestre José, Morales José Luis, Montero-Pérez-Barquero Manuel
Hospital Universitario de Getafe, Madrid, Spain.
Hospital Clinico Universitario "Lozano Blesa", IIS Aragon, Zaragoza, Spain.
Int J Cardiol. 2017 Sep 15;243:332-339. doi: 10.1016/j.ijcard.2017.05.048. Epub 2017 May 12.
Natriuretic peptides or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk renal impairment (RI) in patients with heart failure and reduced ejection fraction (HF-REF). However, the situation in HF patients with preserved ejection fraction (HF-PEF) and mid-range ejection fraction (HF-MREF) remains unclear.
We evaluated patients from the Spanish National Registry of Heart Failure (RICA) that were admitted to Internal Medicine units with acute decompensated HF. Median admission values were used to define elevated NT-proBNP and BUN/creat.
A total of 935 patients were evaluated, 743 with HF-PEF and 192 with HF-MREF). In patients with both NT-proBNP and BUN/creat below median admission values, RI was not associated with mortality (HR 1.15; 95% CI 0.7-1.87, p=0.581 in HF-PEF and HR 1.27; 95% CI 0.58-2.81, p=0.548 in HF-MREF). However, in patients with both elevated NT-proBNP and BUN/creat, those with RI had worse survival than those without RI (HR 2.01, 95% CI 1.33-3.06, p<0.001 in HF-PEF and HR 2.79, 95% CI 1.37-5.67, p=0.005 in HF-MREF). In HF-PEF even patients with RI with only 1 of the 2 parameters elevated, had a substantially higher risk of death compared to patients without RI (HR 1.53; 95% CI 1.04 to 2.26; p=0.031).
In this clinical cohort of acute decompensated HF-PEF and HF-MREF patients, the combined use of NT-proBNP and BUN/creat stratifies patients with RI into groups with significantly different prognoses.
利钠肽或血尿素氮与肌酐比值（BUN/肌酐）可识别射血分数降低的心力衰竭（HF-REF）患者的高风险与低风险肾功能损害（RI）。然而，射血分数保留的心力衰竭（HF-PEF）和射血分数中等范围的心力衰竭（HF-MREF）患者的情况仍不清楚。
我们评估了西班牙国家心力衰竭登记处（RICA）中因急性失代偿性心力衰竭入住内科病房的患者。采用入院时的中位数来定义NT-proBNP和BUN/肌酐升高。
共评估了935例患者，其中743例为HF-PEF患者，192例为HF-MREF患者。在NT-proBNP和BUN/肌酐均低于入院时中位数的患者中，RI与死亡率无关（HF-PEF患者中HR为1.15；95%CI为0.7-1.87，p=0.581；HF-MREF患者中HR为1.27；95%CI为0.58-2.81，p=0.548）。然而，在NT-proBNP和BUN/肌酐均升高的患者中，有RI的患者生存率低于无RI的患者（HF-PEF患者中HR为2.01，95%CI为1.33-3.06，p<0.001；HF-MREF患者中HR为2.79，95%CI为1.37-5.67，p=0.005）。在HF-PEF患者中，即使只有两个参数中的一个升高的RI患者，与无RI的患者相比，死亡风险也显著更高（HR为1.53；95%CI为1.04至2.26；p=0.031）。
在这个急性失代偿性HF-PEF和HF-MREF患者的临床队列中，联合使用NT-proBNP和BUN/肌酐可将RI患者分为预后显著不同的组。
