血浆肾素活性作为心力衰竭患者预后生物标志物的增量预测价值。

Incremental Predictive Value of Plasma Renin Activity as a Prognostic Biomarker in Patients with Heart Failure.

机构信息

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

出版信息

J Korean Med Sci. 2020 Nov 2;35(42):e351. doi: 10.3346/jkms.2020.35.e351.

DOI:10.3346/jkms.2020.35.e351

PMID:33140588

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7606887/

Abstract

BACKGROUND

The association of N-terminal pro-B type natriuretic peptide (NT-proBNP) and plasma renin activity (PRA) for the prognosis of the patients with acute heart failure (HF) has not been fully investigated. This study aimed to determine the association between NT-proBNP and PRA and to investigate the incremental value of PRA to NT-proBNP for predicting long term prognosis in patients with acute HF.

METHODS

Three hundred and ninety-six patients (mean age, 64.7 ± 15.9 years; 46.5% female) presenting with acute HF were enrolled between December 2004 and July 2013. Patients with newly diagnosed HF as well as patients with acute exacerbated chronic HF were included. The prognosis was assessed with the composite event of all-cause mortality and readmission for HF during a 2-year follow-up period.

RESULTS

The etiology of HF was ischemic in 116 (29.3%) patients. In a Cox proportional hazards model, log-transformed PRA (hazard ratio [HR], 1.205; = 0.007) was an independent predictor of the composite outcome of all-cause mortality and readmission for HF in addition to age (HR, 1.032; = 0.001), white blood cell (WBC) count (HR, 1.103; < 0.001), and left ventricular ejection fraction (LVEF) (HR, 0.978; = 0.013). Adding PRA to age, sex, LVEF, and NT-proBNP significantly improved the prediction for the composite outcome of all-cause mortality and readmission for HF, as shown by the net reclassification improvement (0.47; < 0.001) and integrated discrimination improvement (0.10; < 0.001).

CONCLUSION

PRA could provide incremental predictive value to NT-proBNP for predicting long term prognosis in patients with acute HF.

摘要

背景

N 末端脑利钠肽前体（NT-proBNP）和血浆肾素活性（PRA）与急性心力衰竭（HF）患者的预后的相关性尚未得到充分研究。本研究旨在确定 NT-proBNP 与 PRA 之间的关系，并探讨 PRA 对 NT-proBNP 预测急性 HF 患者长期预后的增量价值。

方法

2004 年 12 月至 2013 年 7 月间共纳入 396 例急性 HF 患者（平均年龄 64.7 ± 15.9 岁；46.5%为女性）。包括新发 HF 患者和急性加重的慢性 HF 患者。2 年随访期间的复合终点为全因死亡率和 HF 再入院。

结果

HF 的病因在 116 例（29.3%）患者中为缺血性。在 Cox 比例风险模型中，除年龄（风险比 [HR]，1.032； = 0.001）外，对数转换后的 PRA（HR，1.205； = 0.007）也是全因死亡率和 HF 再入院复合终点的独立预测因子，白细胞计数（HR，1.103； < 0.001）和左心室射血分数（LVEF）（HR，0.978； = 0.013）。将 PRA 与年龄、性别、LVEF 和 NT-proBNP 一起添加到预测模型中，显著提高了全因死亡率和 HF 再入院复合终点的预测效果，表现为净重新分类改善（0.47； < 0.001）和综合判别改善（0.10； < 0.001）。