终末期肾病患者心原性休克的趋势和结局：来自 USRDS 数据库的见解。
Trends and Outcomes of Cardiogenic Shock in Patients With End-Stage Renal Disease: Insights From USRDS Database.
机构信息
Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.).
Medical Student, Class of 2023, University of Kansas Medical Center (H.F.).
出版信息
Circ Heart Fail. 2023 Aug;16(8):e010462. doi: 10.1161/CIRCHEARTFAILURE.122.010462. Epub 2023 Jul 28.
BACKGROUND
There is a paucity of data regarding epidemiology, temporal trends, and outcomes of patients with cardiogenic shock (CS) and end-stage renal disease (chronic kidney disease stage V on hemodialysis).
METHODS
This is a retrospective cohort study using the United States Renal Data System database from January 1, 2006 to December 31, 2019. We analyzed trends of CS, percutaneous mechanical support (intraaortic balloon pump, percutaneous ventricular assist device [Impella and Tandemheart], and extracorporeal membrane oxygenation) utilization, index mortality, 30-day mortality, and 1-year all-cause mortality in end-stage renal disease patients.
RESULTS
A total of 43 825 end-stage renal disease patients were hospitalized with CS (median age, 67.8 years [IQR, 59.4-75.8] and 59.1% men). From 2006 to 2019, the incidence of CS increased from 275 to 578 per 100 000 patients (<0.001). The index mortality rate declined from 54.1% in 2006 to 40.8% in 2019 (=0.44), and the 1-year all-cause mortality decreased from 63% in 2006 to 61.8% in 2018 (=0.73), but neither trend was statistically significant. There was a significantly decreased utilization of intra-aortic balloon pumps from 17 832 to 7992 (<0.001), increased utilization of percutaneous ventricular assist device from 137 to 5201 (<0.001) and increase in extracorporeal membrane oxygenation use from 69 to 904 per 100 000 patients (<0.001). After adjusting for covariates, there was no significant difference in index mortality between CS patients requiring percutaneous mechanical support versus those not requiring percutaneous mechanical support (odds ratio, 0.97 [CI, 0.91-1.02]; =0.22). On multivariable regression analysis, older age, peripheral vascular disease, diabetes, and time on dialysis were independent predictors of higher index mortality.
CONCLUSIONS
The incidence of CS in end-stage renal disease patients has doubled without significant change in the trend of index mortality despite the use of percutaneous mechanical support.
背景
关于心源性休克（CS）和终末期肾病（慢性肾脏病 5 期行血液透析）患者的流行病学、时间趋势和结局数据很少。
方法
这是一项使用美国肾脏数据系统数据库的回顾性队列研究，时间范围为 2006 年 1 月 1 日至 2019 年 12 月 31 日。我们分析了终末期肾病患者 CS、经皮机械支持（主动脉内球囊泵、经皮心室辅助装置[Impella 和 Tandemheart]和体外膜氧合）应用、指数死亡率、30 天死亡率和 1 年全因死亡率的趋势。
结果
共有 43825 例终末期肾病患者因 CS 住院（中位年龄 67.8 岁[IQR，59.4-75.8]，59.1%为男性）。2006 年至 2019 年，CS 的发病率从 275 例/100000 例增加到 578 例/100000 例（<0.001）。指数死亡率从 2006 年的 54.1%下降到 2019 年的 40.8%（=0.44），1 年全因死亡率从 2006 年的 63%下降到 2018 年的 61.8%（=0.73），但均无统计学意义。主动脉内球囊泵的使用率从 17832 例降至 7992 例（<0.001），经皮心室辅助装置的使用率从 137 例增至 5201 例（<0.001），体外膜氧合使用率从 69 例增至 904 例/100000 例（<0.001）。调整协变量后，需要经皮机械支持的 CS 患者与不需要经皮机械支持的 CS 患者的指数死亡率无显著差异（比值比，0.97[CI，0.91-1.02]；=0.22）。多变量回归分析显示，年龄较大、外周血管疾病、糖尿病和透析时间是指数死亡率较高的独立预测因素。
结论
尽管使用了经皮机械支持，但终末期肾病患者 CS 的发病率增加了一倍，而指数死亡率的趋势并无显著变化。
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