Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany.
Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany.
J Eur Acad Dermatol Venereol. 2024 Jul;38(7):1410-1418. doi: 10.1111/jdv.19931. Epub 2024 Feb 29.
Pruritus is a symptom profoundly impairing patients' quality of life (QoL). It is a common symptom in chronic heart failure (CHF) patients of yet unknown nature. The aim of this study was to evaluate the risk factors of pruritus in CHF patients.
For this monocentric, prospective cohort study, CHF patients were recruited and CHF symptoms, comorbidities and drug intake were assessed using a structured report. Additionally, a questionnaire evaluated pruritus symptoms. Detailed medical histories including laboratory test results were retrieved from patient files for all participants.
We evaluated data from 550 CHF patients. Of those, 25.3% reported pruritus to occur frequently (3-5 times per week), often (1-2 times per week) or daily. Patients of higher NYHA classes (NYHA III + IV) experienced significantly more pruritus (31.2%) than lower NYHA classes (NYHA I + II) (21.1%, p = 0.024). Patients with pruritus reported disproportionately often concomitant stasis dermatitis (p = 0.026) and chronic lung disease (p = 0.014). Other parameters reflecting cardiac, liver, kidney and thyroid function, as well as medical therapies showed no significant differences between patients with and without pruritus. In the multivariate logistic regression analysis, only NYHA class (p = 0.016, OR 1.55, 95% confidence interval (CI): [1.09; 2.20]) and elevated leukocyte count (p = 0.007, OR 1.11, CI [1.03; 1.21]) remained significantly associated with pruritus in CHF patients.
NYHA class is an independent predictor for pruritus in CHF patients. Besides NYHA class, leukocyte count was also associated with increased pruritus. Pruritus may impair QoL in CHF patients and should thus be included in the assessment of those patients. We suggest that providing best care for CHF patients can be achieved through an interdisciplinary approach of cardiologists and dermatologists and should include a pruritus assessment.
瘙痒严重影响患者的生活质量（QoL），是慢性心力衰竭（CHF）患者的常见症状，但病因尚不清楚。本研究旨在评估 CHF 患者瘙痒的危险因素。
这是一项单中心前瞻性队列研究，招募 CHF 患者，采用结构化报告评估 CHF 症状、合并症和药物摄入情况。此外，还使用问卷评估瘙痒症状。所有参与者的详细病史，包括实验室检查结果，均从患者病历中检索。
我们评估了 550 例 CHF 患者的数据。其中，25.3%的患者报告瘙痒频繁（每周 3-5 次）、经常（每周 1-2 次）或每天发生。较高 NYHA 分级（NYHA III+IV）的患者瘙痒发生率（31.2%）明显高于较低 NYHA 分级（NYHA I+II）（21.1%，p=0.024）。瘙痒患者报告合并淤滞性皮炎（p=0.026）和慢性肺部疾病（p=0.014）的比例过高。反映心脏、肝脏、肾脏和甲状腺功能以及医疗治疗的其他参数在瘙痒患者和无瘙痒患者之间无显著差异。在多变量逻辑回归分析中，仅 NYHA 分级（p=0.016，OR 1.55，95%置信区间（CI）：[1.09；2.20]）和白细胞计数升高（p=0.007，OR 1.11，CI [1.03；1.21]）与 CHF 患者的瘙痒仍显著相关。
NYHA 分级是 CHF 患者瘙痒的独立预测因子。除 NYHA 分级外，白细胞计数也与瘙痒增加相关。瘙痒可能会降低 CHF 患者的生活质量，因此应将其纳入这些患者的评估中。我们建议，通过心脏病专家和皮肤科医生的跨学科方法为 CHF 患者提供最佳护理，其中应包括瘙痒评估。
