在急性心力衰竭发作期间肾功能恶化及其与短期和长期死亡率的关系：急诊科急性心力衰竭的流行病学研究-肾功能恶化中的相关因素。
Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments- Worsening Renal Function study.
机构信息
Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España.
Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
出版信息
Emergencias. 2020 Sep;32(5):332-339.
OBJECTIVES
To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF).
MATERIAL AND METHODS
Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group.
RESULTS
A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences.
CONCLUSION
AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.
目的
确定与肾功能恶化（WRF）相关的因素，并探讨其与急性心力衰竭（AHF）患者死亡率升高的关系。
材料和方法
在 EAHFE-EFRICA 研究（西班牙语缩写为急诊室急性心力衰竭的流行病学 - WRF 在急性心力衰竭中）的 7 个急诊科连续纳入了在急诊科和 24 至 48 小时后测定肌酐水平的 AHF 患者。WRF 患者的定义是肌酐水平升高 0.3mg/dL 或以上。探讨了 47 项临床特征，以确定与 WRF 相关的特征。为了分析 30 天全因死亡率，我们计算了比值比（ORs）。为了分析随访结束时和每个季度的死亡率，并调整组间差异，我们计算了风险比（HRs）。根据年龄、性别、基线肌酐水平、AHF 类型和风险组，对数据进行了亚组分析。
结果
共纳入 1627 例患者。WRF 亚组 220 例（13.5%）患者年龄较大，收缩压较高，更常接受吗啡治疗，且慢性肾衰竭的发生率更高；WRF 患者中高血压危象作为 AHF 诱因的发生率也更高。然而，只有慢性肾衰竭与 WRF 独立相关（调整后的 OR，1.695；95%CI，1.264-2.273）。总体 30 天死亡率为 13.1%，但 WRF 患者的死亡率更高（20.9% vs 11.8%；调整后的 OR，1.793；95%CI，1.207-2.664）。18 个月的累积死亡率（平均随访时间为 14 个月/患者）总体为 40.0%，但 WRF 患者的死亡率更高（调整后的 HR，1.275；95%CI，1.018-1.598）。第一个季度的风险增加更大。亚组分析未发现差异。
结论
ED 治疗后 48 小时内出现 WRF 的 AHF 与死亡率升高相关，尤其是在急诊后的第一个季度。
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