Tabba Heart Institute, Karachi, Pakistan.
J Pak Med Assoc. 2020 May;70(5):878-883. doi: 10.5455/JPMA.53556.
To calculate frequency of worsening renal failure (WRF) in patients with acute decompensated heart failure (ADHF), to evaluate predictors of WRF and to assess its effect on in-hospital and 12 month adverse outcomes.
A single center observational prospective study was conducted on consecutive patients admitted with ADHF from Sept 2016 - February 2017. Follow-up was done for 12 months post discharge. Data were obtained from electronic medical records and telephonic calls. Early adverse outcome was composite of hospital mortality, prolonged length of stay (LOS) >4days or new need for haemodialysis. Intermediate term adverse event was composite of 12 months all-cause mortality or re-hospitalization.
Total of 247 ADHF patients were admitted. Mean age was 67.6±33.4 years. Males were 163 (65.9%). WRF was found in 57 (23.1%) patients. Predictors of WRF were age>70years, furosemide dose>400mg and admission eGFR <60ml/min. The odds of composite in-hospital outcomes were four times higher in WRF compared to stable renal function (38.6% versus 13.2%, (p<0.01) but were mainly driven by prolonged LOS (4.2 vs. 2.2 days respectively). Follow up was available for 230(97%). Intermediate term outcome was not different between two groups on log rank test.
WRF is a significant problem in ADHF, is common in elderly patients, with baseline impaired renal function and is associated with high requirement of diuretics and prolonged hospital stay. Composite of mortality or HF hospitalization at 12 months was not different between the two groups.
计算急性失代偿性心力衰竭（ADHF）患者肾功能恶化（WRF）的频率，评估WRF 的预测因素，并评估其对住院和 12 个月不良结局的影响。
对 2016 年 9 月至 2017 年 2 月因 ADHF 连续入院的患者进行了一项单中心观察性前瞻性研究。随访时间为出院后 12 个月。数据来自电子病历和电话随访。早期不良结局是住院死亡率、住院时间延长（LOS）>4 天或新需要血液透析的复合指标。中期不良事件是 12 个月全因死亡率或再住院的复合指标。
共收治 247 例 ADHF 患者。平均年龄为 67.6±33.4 岁。男性 163 例（65.9%）。57 例（23.1%）患者出现 WRF。WRF 的预测因素是年龄>70 岁、呋塞米剂量>400mg 和入院时 eGFR<60ml/min。与肾功能稳定的患者相比，WRF 患者发生复合住院结局的几率高 4 倍（38.6%比 13.2%，（p<0.01），但主要是由于 LOS 延长（分别为 4.2 天和 2.2 天）。230 例（97%）患者可进行随访。对数秩检验显示两组患者的中期结局无差异。
WRF 是 ADHF 的一个严重问题，常见于老年患者，伴有基线肾功能受损，与利尿剂需求高和住院时间延长有关。两组患者 12 个月时的死亡率或 HF 住院率无差异。
