Showa University Northern Yokohama Hospital Division of Cardiology and Cardiac Catheterization Laboratories 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan.
Sci Rep. 2020 Mar 10;10(1):4451. doi: 10.1038/s41598-020-61404-5.
There are a few studies about the clinical impacts of plasma B-type natriuretic peptide (BNP) at discharge with the occurrence of worsening renal function (WRF) on mortality in patients with heart failure (HF). We divided total 301 patients with acute decompensated HF into four groups by the median value (278.7 pg/mL) of BNP level at discharge and by the occurrence of WRF. WRF developed in 100 patients (33.2%). Cardiovascular mortality was significantly different between the four groups (P = 0.0002). Patients with WRF and elevated BNP had a higher cardiovascular mortality than patients without WRF and elevated BNP in Cox proportional hazard models (hazard ratio [HR], 10.48; 95% confident interval [95% CI], 1.27-225.53; P = 0.03). Patients with either WRF or elevated BNP did not have an increased risk of cardiovascular mortality compared to patients without WRF and elevated BNP. Regarding HF readmission and cardiovascular mortality, patients with WRF and elevated BNP had the highest risk (HR, 5.17; 95% CI, 2.07-14.30, P = 0.0003) and patients with either WRF or elevated BNP had a higher risk than patients without WRF and elevated BNP. The occurrence of WRF combined with elevated BNP at discharge was associated with increased 1-year cardiovascular mortality and HF readmission.
有一些研究探讨了心力衰竭患者出院时血浆 B 型利钠肽（BNP）水平与肾功能恶化（WRF）对死亡率的临床影响。我们根据 BNP 水平（278.7 pg/mL）的中位数将 301 例急性失代偿性心力衰竭患者分为四组，并根据 WRF 的发生情况进行分组。100 例患者（33.2%）发生了 WRF。四组之间的心血管死亡率存在显著差异（P=0.0002）。在 Cox 比例风险模型中，WRF 伴 BNP 升高的患者心血管死亡率高于无 WRF 和 BNP 升高的患者（风险比[HR]，10.48；95%置信区间[95%CI]，1.27-225.53；P=0.03）。与无 WRF 和 BNP 升高的患者相比，有 WRF 或 BNP 升高的患者心血管死亡率没有增加的风险。关于心力衰竭再入院和心血管死亡率，WRF 伴 BNP 升高的患者风险最高（HR，5.17；95%CI，2.07-14.30，P=0.0003），且有 WRF 或 BNP 升高的患者风险高于无 WRF 和 BNP 升高的患者。出院时 WRF 合并 BNP 升高与 1 年心血管死亡率和心力衰竭再入院增加相关。
