Cardiorenal Med. 2018;8(2):83-91. doi: 10.1159/000476000. Epub 2017 Nov 29.
Volume overload in patients on hemodialysis (HD) is an independent risk factor for cardiovascular mortality. B-lines detected on lung ultrasound (BLUS) assess extravascular lung water. This raises interest in its utility for assessing volume status and cardiovascular outcomes.
End-stage renal disease patients on HD at the Island Rehab Center being older than 18 years were screened. Patients achieving their dry weight (DW) had a lung ultrasound in a supine position. Scores were classified as mild (0-14), moderate (15-30), and severe (>30) for pulmonary congestion. Patients with more than 60 were further classified as very severe. Patients were followed for cardiac events and death.
81 patients were recruited. 58 were males, with a mean age of 59.7 years. 44 had New York Heart Association (NYHA) class 1, 24 had class 2, and 13 had class 3. In univariate analysis, NYHA class was associated with B-line classes (<0.001) and diastolic dysfunction (0.002). In multivariate analysis, NYHA grade strongly correlated with B-line classification (0.01) but not with heart function (0.95). 71 subjects were followed for a mean duration of 1.19 years. 9 patients died and 20 had an incident cardiac event. A Kaplan-Meier survival analysis demonstrated an interval decrease in survival times in all-cause mortality and cardiac events with increased BLUS scores (p = 0.0049). Multivariate Cox regression analysis showed the independent predictive value of BLUS class for mortality and cardiac events with a heart rate of 2.98 and 7.98 in severe and very severe classes, respectively, compared to patients in the mild class (p = 0.025 and 0.013).
At DW, BLUS is an independent risk factor for death and cardiovascular events in patients on HD.
血液透析（HD）患者的容量超负荷是心血管死亡率的独立危险因素。肺部超声（BLUS）上检测到的 B 线评估肺外血管水。这引起了人们对其评估容量状态和心血管结局的效用的兴趣。
在岛康复中心接受 HD 的年龄大于 18 岁的终末期肾脏疾病患者进行了筛选。达到干体重（DW）的患者在仰卧位进行肺部超声检查。根据肺充血程度将评分分为轻度（0-14）、中度（15-30）和重度（>30）。年龄超过 60 岁的患者进一步分为非常严重。对患者进行心脏事件和死亡随访。
共招募了 81 名患者。其中 58 名男性，平均年龄为 59.7 岁。44 名患者为纽约心脏协会（NYHA）心功能分级 1 级，24 名患者为 NYHA 心功能分级 2 级，13 名患者为 NYHA 心功能分级 3 级。在单因素分析中，NYHA 心功能分级与 B 线分级（<0.001）和舒张功能障碍（0.002）相关。在多因素分析中，NYHA 分级与 B 线分类密切相关（0.01），但与心功能无关（0.95）。71 例患者平均随访 1.19 年。9 例患者死亡，20 例发生心脏事件。Kaplan-Meier 生存分析显示，随着 BLUS 评分的增加，全因死亡率和心脏事件的生存时间呈间隔性下降（p = 0.0049）。多因素 Cox 回归分析显示，BLUS 分级是 HD 患者死亡和心脏事件的独立预测因素，严重和非常严重组的心率分别为 2.98 和 7.98，与轻度组相比（p = 0.025 和 0.013）。
在 DW 时，BLUS 是 HD 患者死亡和心血管事件的独立危险因素。
