Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
General Internal Medicine Division, Geneva University Hospitals, Geneva, Switzerland; and.
Clin J Am Soc Nephrol. 2017 Oct 6;12(10):1624-1633. doi: 10.2215/CJN.04020417. Epub 2017 Aug 11.
It is unknown whether echocardiographic parameters are independently associated with the cardiorenal syndrome. No direct comparison of the natural history of various cardiorenal syndrome types has been conducted.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our retrospective cohort study enrolled adult patients with at least one transthoracic echocardiography between 2004 and 2014 at a single health care system. Information on comorbidities was extracted using condition-specific diagnostic codes. All-cause mortality was the primary outcome among patients with cardiorenal syndrome types 1-4. Myocardial infarction and stroke were the secondary outcomes.
In total, 30,681 patients were included, and 2512 (8%) developed at least one of the cardiorenal syndromes: 1707 patients developed an acute form of the syndrome (type 1 or 3), 128 patients developed type 2, and 677 patients developed type 4. In addition, 16% of patients with type 2 and 20% of patients with type 4 also developed an acute cardiorenal syndrome, whereas 14% of patients with acute cardiorenal progressed to CKD or chronic heart failure. Decreasing left ventricular ejection fraction, increasing pulmonary artery pressure, and higher right ventricular diameter were independently associated with higher incidence of a cardiorenal syndrome. Acute cardiorenal syndrome was associated with the highest risk of death compared with patients with CKD without cardiorenal syndrome (hazard ratio, 3.13; 95% confidence interval, 2.72 to 3.61; <0.001). Patients with cardiorenal type 4 had better survival than patients with acute cardiorenal syndrome (hazard ratio, 0.48; 95% confidence interval, 0.37 to 0.61; <0.001). Patients with acute cardiorenal syndrome and type 4 had increased risk of myocardial infarction and stroke compared with patients with CKD without cardiorenal syndrome.
Up to 19% of patients with a chronic form of cardiorenal syndrome will subsequently develop an acute syndrome. Development of acute or type 4 cardiorenal syndrome is independently associated with mortality, the acute form having the worst prognosis.
心脏-肾脏综合征患者的超声心动图参数是否与该综合征独立相关仍不清楚。目前尚未对各种心脏-肾脏综合征类型的自然病程进行直接比较。
设计、设置、参与者和测量：本回顾性队列研究纳入了 2004 年至 2014 年间在单一医疗保健系统中至少进行过一次经胸超声心动图检查的成年患者。使用特定疾病的诊断代码提取合并症信息。所有原因死亡率是心脏-肾脏综合征 1-4 型患者的主要结局。心肌梗死和卒中为次要结局。
共纳入 30681 例患者，其中 2512 例（8%）发生至少一种心脏-肾脏综合征：1707 例发生急性心脏-肾脏综合征（1 型或 3 型），128 例发生 2 型，677 例发生 4 型。此外，2 型患者中有 16%和 4 型患者中有 20%还发生急性心脏-肾脏综合征，而 14%的急性心脏-肾脏综合征患者进展为慢性肾脏病或慢性心力衰竭。左心室射血分数降低、肺动脉压升高和右心室直径增大与心脏-肾脏综合征发生率增加独立相关。与无心脏-肾脏综合征的慢性肾脏病患者相比，急性心脏-肾脏综合征患者的死亡风险最高（风险比，3.13；95%置信区间，2.72 至 3.61；<0.001）。心脏-肾脏 4 型患者的生存情况优于急性心脏-肾脏综合征患者（风险比，0.48；95%置信区间，0.37 至 0.61；<0.001）。与无心脏-肾脏综合征的慢性肾脏病患者相比，急性心脏-肾脏综合征和 4 型患者发生心肌梗死和卒中的风险增加。
多达 19%的慢性心脏-肾脏综合征患者随后会发展为急性综合征。发生急性或 4 型心脏-肾脏综合征与死亡率独立相关，其中急性形式的预后最差。
