Emergency Department, Hospital Universitari de Vic, Spain.
Emergency Department, Hospital Universitari de Bellvitge, Spain.
Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):406-418. doi: 10.1177/2048872620921602. Epub 2020 May 14.
The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes.
We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate <60 ml/min/m, anaemia by haemoglobin values <12/<13 g/dl in women/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS-) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+/A-, RD-/A+) or in combination (RD+/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD-/A-). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (>10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation/death. These short-term outcomes were compared and adjusted for differences among groups.
Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS- (hazard ratio = 1.46, 95% confidence interval = 1.26-1.68) and RD-/A- (hazard ratio = 1.83, 95% confidence interval = 1.46-2.28) control groups. The mortality level was also higher in RD+/A- (hazard ratio = 1.40, 95% confidence interval = 1.10-1.78) and higher, but not statistically significant, in RD-/A+ (hazard ratio = 1.28, 95% confidence interval = 0.99-1.63) with respect to RD-/A-. All of the secondary outcomes, when related to CRAS- and RD-/A- control groups, were worse for CRAS+ and to a lesser extent, RD+/A-, being more rarely observed in RD-/A+.
Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.
急性心力衰竭伴其他合并症的患者预后较差。本研究旨在确定急性心力衰竭伴心肾贫血综合征患者的特征，以及肾功能障碍和贫血（单独或联合为心肾贫血综合征）与短期结局的关系。
我们分析了急性心力衰竭的流行病学在急诊部门登记处（西班牙急诊部门急性心力衰竭患者队列）。肾功能障碍定义为估算肾小球滤过率＜60ml/min/ml，贫血定义为血红蛋白值＜12/g/dl（女性）/＜13g/dl（男性），心肾贫血综合征则同时存在以上两种情况。根据心肾贫血综合征阳性（CRAS+）与其余患者（CRAS-）以及根据肾功能障碍（RD+）和贫血（A+）的存在情况进行比较（单独的 RD+/A-、RD-/A+）或联合（RD+/A+；即 CRAS+）与无肾功能障碍和贫血的患者（RD-/A-）进行比较。主要结局为 30 天死亡率，次要结局为需要入院、延长住院时间（＞10 天）、指数事件期间院内死亡率、再次就诊以及 30 天出院后再次就诊/死亡的组合。比较并调整了这些短期结局在各组之间的差异。
在分析的 13307 例患者中，CRAS+（36.4%）与年龄较大、多种合并症、慢性使用袢利尿剂、水肿和低血压有关。与 CRAS-（危险比=1.46，95%置信区间=1.26-1.68）和 RD-/A-（危险比=1.83，95%置信区间=1.46-2.28）对照组相比，CRAS+患者 30 天死亡率更高。RD+/A-（危险比=1.40，95%置信区间=1.10-1.78）和 RD-/A+（危险比=1.28，95%置信区间=0.99-1.63）组的死亡率也更高，但与 RD-/A-相比，差异无统计学意义。与 CRAS-和 RD-/A-对照组相比，所有次要结局在 CRAS+中均较差，在 RD+/A-中较差，但程度较轻，在 RD-/A+中更少见。
急性心力衰竭中心肾贫血综合征与死亡率增加和短期结局恶化相关，肾功能障碍和贫血的影响似乎是累加的。
