Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany.
Present Address: Department of Internal Medicine III, Nephrology, Rheumatology and Endocrinology, University Hospital Hamburg (UKE), Hamburg, Germany.
BMC Nephrol. 2021 Mar 2;22(1):77. doi: 10.1186/s12882-021-02274-5.
Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR.
Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup.
Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15-0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05-0.44]) compared to patients without RI.
We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit.
慢性肾脏病和急性肾损伤与经导管主动脉瓣置换术（TAVR）后的不良结局相关。然而，对于 TAVR 后肾功能改善的预后意义知之甚少。
肾改善（RI）定义为与术前基线值相比，术后肌酐降低≥1%。计算代表 RI 可能性的倾向评分，以定义在潜在混杂因素（年龄、性别、BMI、NYHA 分级、STS 评分、log. EuroSCORE、房颤/房扑史、肺部疾病、既往中风、CRP、肌酐、hsTNT 和 NT-proBNP）方面具有可比性的患者组。根据该倾向评分将队列分为 5 个五分位组，并比较每组亚组的 TAVR 后生存时间。
五分位 5 组（n=93）的 RI 可能性最高。他们的特点是肌酐较高、eGFR 较低、NYHA 分级较高、NT-proBNP 较高，多为女性，总生存时间较短。在五分位 5 组中，无 RI 的患者与有 RI 的患者相比，生存时间明显更短（p=0.002，HR=0.32，95%CI=[0.15-0.69]）。在整个队列（p=0.12）和五分位 1 至 4 （均 p>0.16）中，有 RI 和无 RI 的患者之间没有生存时间差异。对特定亚组的分析表明，在 NYHA 分级为 IV 的患者中，与无 RI 的患者相比，有 RI 的患者的生存时间也有显著获益（p<0.001，HR=0.15；95%-CI=[0.05-0.44]）。
我们在这里描述了一个基于倾向评分的特定患者亚组，其中 TAVR 后的 RI 与显著的生存获益相关。
