Kido Takehiko, Okabe Toshitaka, Narui Shuro, Fujioka Tatsuki, Ishigaki Shigehiro, Usumoto Soichiro, Asukai Yu, Kimura Taro, Shimazu Suguru, Saito Jumpei, Oyama Yuji, Igawa Wataru, Ono Morio, Ebara Seitaro, Yamamoto Myong Hwa, Yakushiji Tadayuki, Isomura Naoei, Ochiai Masahiko
Division of Cardiology, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
Heart Vessels. 2023 Feb;38(2):207-215. doi: 10.1007/s00380-022-02160-6. Epub 2022 Aug 29.
This study aimed to determine the optimal cut-off value of the early drop in systolic blood pressure (SBP) for worsening renal function (WRF) in hospitalized patients with heart failure (HF) and analyze predictors of WRF and the early drop in SBP at that threshold. We retrospectively enrolled 396 patients with acute decompensated HF. The early drop in SBP was defined as the difference between baseline and SBP measured 24 h after hospitalization. We performed receiver operating characteristic (ROC) analysis to determine the optimal cut-off value of the early drop in SBP for WRF and evaluated the effect of the early drop in SBP on in-hospital mortality by multivariate logistic regression analyses. The mean age of the patients was 73.4 ± 14.7 years, and 61.2% were men. A 14.0% drop in SBP was identified as the optimal cut-off value for WRF from the ROC curve analysis. An early drop in SBP ≥ 14.0% was associated with WRF in multivariate logistic regression analysis (odds ratio 7.84; 95% confidence interval 4.06-15.14; P < 0.0001). The dose of intravenous furosemide within 24 h of admission was one of the predictors of the early drop in SBP ≥ 14.0%, while no early drop in SBP was a predictor of in-hospital mortality in multivariate logistic regression models. In conclusion, the optimal cut-off value for WRF in patients with HF was a 14.0% drop in SBP within 24 h of admission. The early drop in SBP ≥ 14.0% was one of the predictors of WRF in patients with HF. However, no early drop in SBP was associated with in-hospital mortality. This study was registered with the University Hospital Medical Information Network in Japan (UMIN000035989).
本研究旨在确定住院心力衰竭（HF）患者肾功能恶化（WRF）时收缩压（SBP）早期下降的最佳截断值，并分析WRF的预测因素以及该阈值下SBP的早期下降情况。我们回顾性纳入了396例急性失代偿性HF患者。SBP的早期下降定义为基线值与住院24小时后测得的SBP之间的差值。我们进行了受试者工作特征（ROC）分析以确定WRF时SBP早期下降的最佳截断值，并通过多因素逻辑回归分析评估SBP早期下降对住院死亡率的影响。患者的平均年龄为73.4±14.7岁，男性占61.2%。通过ROC曲线分析确定SBP下降14.0%为WRF的最佳截断值。在多因素逻辑回归分析中，SBP早期下降≥14.0%与WRF相关（比值比7.84；95%置信区间4.06 - 15.14；P<0.0001）。入院24小时内静脉注射呋塞米的剂量是SBP早期下降≥14.0%的预测因素之一，而在多因素逻辑回归模型中，SBP无早期下降是住院死亡率的预测因素。总之，HF患者WRF的最佳截断值是入院24小时内SBP下降14.0%。SBP早期下降≥14.0%是HF患者WRF的预测因素之一。然而，SBP无早期下降与住院死亡率相关。本研究在日本大学医院医学信息网络注册（UMIN000035989）。
