Ji Run-Qing, Wang Bin, Zhang Jin-Guo, Su Shu-Hong, Li Li, Yu Qin, Jiang Xian-Yan, Fu Xin, Fang Xue-Hua, Ma Xiao-Wen, Tian Ao-Xi, Li Jing
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
J Geriatr Cardiol. 2023 Jul 28;20(7):516-526. doi: 10.26599/1671-5411.2023.07.006.
Clinical outcomes are poor if patients with acute heart failure (AHF) are discharged with residual congestion in the presence of renal dysfunction. However, there is no single indication to reflect the combined effects of the two related pathophysiological processes. We, therefore, proposed an indicator, congestion and renal index (CRI), and examined the associations between the CRI and one-year outcomes and the incremental prognostic value of CRI compared with the established scoring systems in a multicenter prospective cohort of AHF.
We enrolled AHF patients and calculated the ratio of thoracic fluid content index divided by estimated glomerular filtration rate before discharge, as CRI. Then we examined the associations between CRI and one-year outcomes.
A total of 944 patients were included in the analysis (mean age 63.3 ± 13.8 years, 39.3% women). Compared with patients with CRI ≤ 0.59 mL/min per kΩ, those with CRI > 0.59 mL/min per kΩ had higher risks of cardiovascular death or HF hospitalization (HR = 1.56 [1.13-2.15]) and all-cause death or all-cause hospitalization (HR = 1.33 [1.01-1.74]). CRI had an incremental prognostic value compared with the established scoring system.
In patients with AHF, CRI is independently associated with the risk of death or hospitalization within one year, and improves the risk stratification of the established risk models.
急性心力衰竭（AHF）患者若在肾功能不全的情况下出院时仍有残余充血，临床结局较差。然而，尚无单一指标能反映这两个相关病理生理过程的综合影响。因此，我们提出了一个指标，即充血与肾脏指数（CRI），并在一个多中心前瞻性AHF队列中研究了CRI与一年结局之间的关联以及CRI相对于既定评分系统的增量预后价值。
我们纳入了AHF患者，并计算出院前胸腔积液含量指数除以估计肾小球滤过率的比值作为CRI。然后我们研究了CRI与一年结局之间的关联。
共有944例患者纳入分析（平均年龄63.3±13.8岁，女性占39.3%）。与CRI≤0.59 mL/（min·kΩ）的患者相比，CRI>0.59 mL/（min·kΩ）的患者发生心血管死亡或心力衰竭住院的风险更高（HR=1.56[1.13-2.15]），全因死亡或全因住院的风险更高（HR=1.33[1.01-1.74]）。与既定评分系统相比，CRI具有增量预后价值。
在AHF患者中，CRI与一年内死亡或住院风险独立相关，并改善了既定风险模型的风险分层。
