Department of Emergency and Hospital Medicine, Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania; Morsani College of Medicine, University of South Florida, Tampa, Florida.
Department of Emergency and Hospital Medicine, Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania.
Am J Cardiol. 2021 Mar 1;142:97-102. doi: 10.1016/j.amjcard.2020.11.041. Epub 2020 Dec 4.
Acute heart failure (HF) management is a complex and often involves a delicate balance of both cardiac and renal systems. Although pharmacologic diuresis is a mainstay of the pharmacologic management of decompensated HF, ultrafiltration (UF) represents a nonpharmacologic approach in the setting of diuretic resistance. We conducted a cross-sectional analysis of the 2009 through 2014 hospitalization data from the National Inpatient Sample. The study population consisted of hospitalizations with a discharge Diagnosis Related Groups of HF who were older than 18 years of age, did not have end-stage kidney disease, acute kidney injury and had not undergone hemodialysis or hemofiltration. There were 6,174 hospitalizations which included UF among the 7,799,915 hospitalizations for HF. Hospitalizations which included UF were among patients significantly younger in age (68.1 ± 1.0 vs 73.8 ± 0.1 years), male (61.9% vs 47.7%), and with higher prevalence of co-morbid conditions including chronic kidney disease (58% vs 31%), diabetes mellitus (53% vs 42%), and higher rates of co-morbidity (Charlson comorbidity score ≥2, 92% vs 80%). All-cause mortality was significantly higher among hospitalizations which included an UF (4.68% vs 2.24%). Hospitalizations with UF had a longer mean length of stay (6.2 vs 4.3 days, p <0.01) average total charges ($42,035 vs 24,867 USD, p <0.01) as compared with those without UF. Hospitalizations with UF were associated with a greater adjusted odds of all-cause mortality (odds ratio: 3.36, [95% confidence interval 1.76,6.40]), greater than DRG-level target length of stay (odds ratio, 2.46; [95 confidence interval 1.65,3.67]), and a 72% increase in the average hospital charges. In conclusion, hospitalizations which included UF identified a subgroup of HF patients with more co-morbid conditions who are at higher risk of mortality and increased resource burden in terms of length of stay and costs. These findings also highlight that the need for UF may identify patients who are most likely to benefit from a multidisciplinary cardiorenal approach to alter the trajectory of their disease.
急性心力衰竭（HF）的管理是一个复杂的过程，通常涉及到心脏和肾脏系统之间的微妙平衡。尽管药物利尿是失代偿性 HF 药物治疗的主要方法，但超滤（UF）是在利尿剂抵抗的情况下的一种非药物治疗方法。我们对 2009 年至 2014 年国家住院患者样本的住院数据进行了横断面分析。研究人群包括年龄大于 18 岁、无终末期肾病、急性肾损伤且未接受血液透析或血液滤过的因 HF 出院的患者。在因 HF 住院的 7799915 例患者中，有 6174 例患者接受了 UF。与未接受 UF 的患者相比，接受 UF 的患者年龄明显较小（68.1±1.0 岁 vs 73.8±0.1 岁），男性比例较高（61.9% vs 47.7%），且共病发生率较高，包括慢性肾脏病（58% vs 31%）、糖尿病（53% vs 42%），且共病发生率更高（Charlson 合并症评分≥2，92% vs 80%）。接受 UF 的患者全因死亡率明显较高（4.68% vs 2.24%）。与未接受 UF 的患者相比，接受 UF 的患者平均住院时间更长（6.2 天 vs 4.3 天，p<0.01），总费用更高（42035 美元 vs 24867 美元，p<0.01）。与未接受 UF 的患者相比，接受 UF 的患者全因死亡率的调整后比值比更高（比值比：3.36，[95%置信区间 1.76，6.40]），DRG 水平目标住院时间更长（比值比，2.46；[95%置信区间 1.65，3.67]），平均住院费用增加 72%。总之，接受 UF 的患者住院患者确定了一个具有更多合并症的 HF 患者亚组，这些患者的死亡率更高，且在住院时间和费用方面的资源负担增加。这些发现还强调，需要 UF 可能会识别出最有可能受益于多学科心脏肾脏治疗方法的患者，以改变其疾病的轨迹。
