肾功能作为急性肺栓塞危险分层和短期预后的一个影响因素。
Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism.
机构信息
Center for thrombosis and hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; Cardiology I, Center of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.
出版信息
Exp Gerontol. 2017 Dec 15;100:11-16. doi: 10.1016/j.exger.2017.10.007. Epub 2017 Oct 13.
BACKGROUND
In addition to right ventricular dysfunction (RVD) and myocardial injury, impaired renal function is connected with poorer prognosis in pulmonary embolism (PE). We aimed to investigate renal function as a cofactor for risk stratification in PE.
METHODS
Data from 182 patients with PE, treated between May 2006 and June 2011, were analysed retrospectively. PE patients with elevated creatinine were compared with those with normal values. Logistic regression models were calculated to investigate associations between creatinine and myocardial necrosis, RVD and in-hospital death. Prognostic performance of creatinine for prediction of myocardial necrosis and RVD were computed.
RESULTS
Overall, 182 patients (61.5% females,aged 68.5±15.3years) with confirmed PE were included in this study; 142 patients(78.0%) showed normal creatinine, and 40(22.0%) had an elevated creatinine. Patients with elevated creatinine were older (75.9±10.7 vs. 66.5±15.7years, P=0.0003), more frequently female (77.5% vs. 57.0%,P=0.019), and had higher cardiac troponin I (0.19±0.23 vs. 0.11±0.29ng/ml,P=0.0004), systolic pulmonary artery pressure (43.18±16.69 vs. 30.83±17.53mmHG,P=0.0006) and percentage of RVD (77.1% vs. 54.1%,P=0.040). Creatinine was significantly and independently associated with myocardial necrosis (OR 10.192, 95%CI 2.850-36.452, P=0.0004), shock-index≥1.0 (OR 3.265, 95%CI 1.067-9.992, P=0.0381) and RVD (OR 5.172, 95%CI 1.387-19.295, P=0.014). Creatinine>1.25mg/dl indicated for myocardial necrosis (AUC 0.680) and RVD (AUC 0.663).
CONCLUSIONS
Additionally, to RVD and myocardial necrosis, impaired renal function could give further information for risk stratification in PE. Cardio-pulmonary-renal interactions in PE seem to be multi-factorial.
背景
除了右心室功能障碍（RVD）和心肌损伤外，肾功能受损与肺栓塞（PE）的预后较差有关。我们旨在研究肾功能作为 PE 风险分层的辅助因素。
方法
回顾性分析了 2006 年 5 月至 2011 年 6 月期间治疗的 182 例 PE 患者的数据。比较了血肌酐升高的 PE 患者与血肌酐正常的患者。计算了逻辑回归模型以研究肌酐与心肌坏死、RVD 和院内死亡之间的关系。计算了肌酐对预测心肌坏死和 RVD 的预后性能。
结果
总体而言，本研究纳入了 182 例（61.5%为女性，年龄 68.5±15.3 岁）确诊为 PE 的患者；142 例（78.0%）血肌酐正常，40 例（22.0%）血肌酐升高。血肌酐升高的患者年龄更大（75.9±10.7 岁 vs. 66.5±15.7 岁，P=0.0003），更常为女性（77.5% vs. 57.0%，P=0.019），且心脏肌钙蛋白 I 更高（0.19±0.23 vs. 0.11±0.29ng/ml，P=0.0004），收缩期肺动脉压更高（43.18±16.69 vs. 30.83±17.53mmHg，P=0.0006），RVD 百分比更高（77.1% vs. 54.1%，P=0.040）。肌酐与心肌坏死（OR 10.192，95%CI 2.850-36.452，P=0.0004）、休克指数≥1.0（OR 3.265，95%CI 1.067-9.992，P=0.0381）和 RVD（OR 5.172，95%CI 1.387-19.295，P=0.014）显著相关。肌酐>1.25mg/dl 提示心肌坏死（AUC 0.680）和 RVD（AUC 0.663）。
结论
除了 RVD 和心肌坏死外，肾功能受损还可以为 PE 的风险分层提供进一步的信息。PE 中的心肺肾相互作用似乎是多因素的。
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