Feng S T, Fan P, Hao S, Bai Q, Wang L X, Jia Lixin
Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Coronary Artery Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2022 Aug 16;102(30):2368-2373. doi: 10.3760/cma.j.cn112137-20220219-00338.
To analyze the related factors of worsening renal function (WRF) in patients with acute right ventricular myocardial infarction (RVMI) during hospitalization. A total of 98 patients with acute RVMI admitted to the emergency comprehensive ward of Beijing Anzhen Hospital from August 2011 to January 2020 were enrolled in this cross-sectional study. According to the situation of WRF, the patients were divided into non-WRF group (76 cases) and WRF group (22 cases). WRF was defined as ≥0.3 mg/dL increase in serum creatinine level from baseline on day 6 of hospitalization (if hospital stay<6 days, it was at discharge). Baseline data, intravenous fluid infusion, diuretic and significant positive balance of patients' intake and output volume [any 24 h intakes and outputs ≥1 000 ml or any consecutive 72 h intakes and outputs ≥2 000 ml within 6 d of hospitalization (if hospitalization<6 d, it was from admission to discharge)] were obtained, and the differences of above indicators between the two groups were analyzed. Multiple logistic regression model was used to analyze the related factors of WRF. The ages of patients in WRF group and non-WRF group were 60 (50, 68) and 63 (52, 72) years, and the male proportions were 63.6% (14 cases) and 76.3% (58 cases), respectively, and there was no significant difference (all >0.05). The proportion of positive balance was 31.8% (7 cases) in WRF group, which was higher than 14.5% (11 cases) in non-WRF group (=0.034). The rate of loop diuretic use in WRF group was 4.5% (1 case), lower than that in non-WRF group 10.5% (8 cases) (=0.027). After adjusting for age, sex, baseline estimated glomerular filtration rate (eGFR), preoperative isoproterenol/temporary pacemaker/atropine use, significant positive balance of intake and output volume, and loop diuretic use, it was found that eGFR≥60 ml·min·1.73 m and significant positive balance were associated with WRF, the (95%) were 0.71 (0.62-0.86) and 1.21 (1.02-1.43) (both <0.05); After eliminating the variable of significant positive balance in the above model, loop diuretic use was found to be a correlation factor for WRF, with an (95%) of 0.89 (0.72-0.97) (<0.05). Significant positive balance of intake and output volume during hospitalization in patients with acute RVMI is a risk factor for WRF on day 6 or at discharge. In the presence of a significant positive balance, loop diuretic use is a protective factor for WRF.
分析急性右心室心肌梗死（RVMI）患者住院期间肾功能恶化（WRF）的相关因素。选取2011年8月至2020年1月在北京安贞医院急诊综合病房收治的98例急性RVMI患者纳入本横断面研究。根据WRF情况，将患者分为非WRF组（76例）和WRF组（22例）。WRF定义为住院第6天血清肌酐水平较基线升高≥0.3 mg/dL（若住院时间<6天，则为出院时）。获取患者的基线数据、静脉输液量、利尿剂使用情况以及出入量显著正平衡情况[住院6天内任何24小时出入量≥1000 ml或任何连续72小时出入量≥2000 ml（若住院时间<6天，则为入院至出院）]，并分析两组上述指标的差异。采用多因素logistic回归模型分析WRF的相关因素。WRF组和非WRF组患者年龄分别为60（50，68）岁和63（52，72）岁，男性比例分别为63.6%（14例）和76.3%（58例），差异均无统计学意义（均>0.05）。WRF组正平衡比例为31.8%（7例），高于非WRF组的14.5%（11例）（P = 0.034）。WRF组袢利尿剂使用率为4.5%（1例），低于非WRF组的10.5%（8例）（P = 0.027）。校正年龄、性别、基线估算肾小球滤过率（eGFR）、术前异丙肾上腺素/临时起搏器/阿托品使用情况、出入量显著正平衡以及袢利尿剂使用情况后，发现eGFR≥60 ml·min·1.73 m²和出入量显著正平衡与WRF相关，比值比（95%可信区间）分别为0.71（0.62 - 0.86）和1.21（1.02 - 1.43）（均<0.05）；在上述模型中剔除出入量显著正平衡变量后，发现袢利尿剂使用是WRF的相关因素，比值比（95%可信区间）为0.89（0.72 - 0.97）（<0.05）。急性RVMI患者住院期间出入量显著正平衡是第6天或出院时WRF的危险因素。在存在出入量显著正平衡的情况下，袢利尿剂使用是WRF的保护因素。
