估算肾小球滤过率对急诊就诊的高血压危象患者长期死亡率的影响。
Impact of the estimated glomerular filtration rate on long-term mortality in patients with hypertensive crisis visiting the emergency department.
机构信息
Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.
出版信息
PLoS One. 2022 Mar 31;17(3):e0266317. doi: 10.1371/journal.pone.0266317. eCollection 2022.
BACKGROUND
The association between renal function and all-cause mortality in patients with hypertensive crisis remains unclear. We aimed to identify the impact of estimated glomerular filtration rate (eGFR) on all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED).
METHODS
This retrospective study included patients aged ≥18 years admitted to the ED between 2016 and 2019 for hypertensive crisis (systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥110 mmHg). They were classified into four groups according to the eGFR at admission to the ED: ≥90, 60-89, 30-59, and <30 mL/min/1.73 m2.
RESULTS
Among the 4,821 patients, 46.7% and 5.8% had an eGFR of ≥90 and <30 mL/min/1.73 m2, respectively. Patients with lower eGFR were older and more likely to have comorbidities. The 3-year all-cause mortality rates were 7.7% and 41.9% in those with an eGFR ≥90 and <30 mL/min/1.73 m2, respectively. After adjusting for confounding variables, those with an eGFR of 30-59 (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.47-2.54) and <30 mL/min/1.73 m2 (HR, 2.35; 95% CI, 1.71-3.24) had significantly higher 3-year all-cause mortality risks than those with an eGFR of ≥90 mL/min/1.73 m2. Patients with an eGFR of 60-89 mL/min/1.73 m2 had a higher mortality (21.1%) than those with an eGFR of ≥90 mL/min/1.73 m2 (7.7%); however, the difference was not significant (HR, 1.21; 95% CI, 0.94-1.56).
CONCLUSIONS
Renal impairment is common in patients with hypertensive crisis who visit the ED. A strong independent association was observed between decreased eGFR and all-cause mortality in these patients. eGFR provides useful prognostic information and permits the early identification of patients with hypertensive crisis with an increased mortality risk. Intensive treatment and follow-up strategies are needed for patients with a decreased eGFR who visit the ED.
背景
肾功能与高血压危象患者全因死亡率之间的关系尚不清楚。我们旨在确定估算肾小球滤过率（eGFR）对因高血压危象而就诊于急诊部（ED）的患者的全因死亡率的影响。
方法
本回顾性研究纳入了 2016 年至 2019 年间因高血压危象（收缩压≥180mmHg 和/或舒张压≥110mmHg）而就诊于 ED 的年龄≥18 岁的患者。根据 ED 就诊时的 eGFR 将他们分为四组：≥90、60-89、30-59 和<30mL/min/1.73m2。
结果
在 4821 名患者中，46.7%和 5.8%的患者 eGFR 分别为≥90 和<30mL/min/1.73m2。eGFR 较低的患者年龄较大，且更有可能合并有其他疾病。eGFR≥90 和<30mL/min/1.73m2的患者的 3 年全因死亡率分别为 7.7%和 41.9%。在调整了混杂变量后，eGFR 为 30-59（风险比[HR]，1.93；95%置信区间[CI]，1.47-2.54）和<30mL/min/1.73m2（HR，2.35；95%CI，1.71-3.24）的患者 3 年全因死亡率的风险显著高于 eGFR≥90mL/min/1.73m2的患者。eGFR 为 60-89mL/min/1.73m2的患者的死亡率（21.1%）高于 eGFR≥90mL/min/1.73m2的患者（7.7%）；然而，差异无统计学意义（HR，1.21；95%CI，0.94-1.56）。
结论
肾功能损害在因高血压危象而就诊于 ED 的患者中很常见。在这些患者中，eGFR 降低与全因死亡率之间存在强烈的独立关联。eGFR 提供了有用的预后信息，并允许早期识别出死亡率增加的高血压危象患者。对于就诊于 ED 的 eGFR 降低的患者，需要采用强化治疗和随访策略。
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