Biegus Jan, Cotter Gad, Davison Beth A, Freund Yonathan, Voors Adriaan A, Edwards Christopher, Novosadova Maria, Takagi Koji, Hayrapetyan Hamlet, Mshetsyan Andranik, Mayranush Drambyan, Cohen-Solal Alain, Ter Maaten Jozine M, Filippatos Gerasimos, Chioncel Ovidiu, Sadoune Malha, Pagnesi Matteo, Simon Tabassome, Metra Marco, Mann Douglas L, Mebazaa Alexandre, Ponikowski Piotr
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Heart Initiative, Durham, NC, USA; Momentum Research Inc, Durham, NC, USA.
J Card Fail. 2025 Feb;31(2):354-366. doi: 10.1016/j.cardfail.2024.09.002. Epub 2024 Sep 29.
The effect of steroids on congestion in patients with acute heart failure (AHF) is not known.
Patients with AHF, NT-proBNP levels > 1500 pg/mL and high-sensitivity C-reactive protein (hsCRP) levels > 20 mg/L were randomized to once-daily oral 40 mg prednisone for 7 days or usual care. In this post hoc analysis, congestion score was calculated on the basis of orthopnea, edema and rales (0 reflecting lack of congestion, and 9 maximal congestion) at each time point. Among 100 eligible patients randomized, those assigned to prednisone had a greater improvement in congestion score at day 31 (win odds for the prednisone group compared to usual care at day 31 was 1.77 (95% CI 1.17-2.84; P = 0.0066) in all patients and 2.41 (95% CI 1.37-5.05; P = 0.0016) in patients with IL-6 > 13 pg/mL at baseline. In patients with congestion scores ≥ 7 at baseline, the effects of prednisone therapy on the EQ-5D visual analog scale score were 4.30 (95% CI 0.77-7.83) points at day 7 and 5.40 (0.51-10.29) points at day 31, accompanied by lower heart rate and respiratory rate and higher oxygen saturation compared to usual care.
In patients with AHF and inflammatory activation, 7-day steroid therapy was associated with reduction in signs of congestion up to day 31. These results need confirmation in larger studies examining potential effects of steroids on congestion, diuresis, fluid redistribution and vascular permeability as well as clinical effects in AHF.
类固醇对急性心力衰竭（AHF）患者充血的影响尚不清楚。
将NT-proBNP水平>1500 pg/mL且高敏C反应蛋白（hsCRP）水平>20 mg/L的AHF患者随机分为两组，一组每日口服40 mg泼尼松，共7天，另一组接受常规治疗。在这项事后分析中，根据每个时间点的端坐呼吸、水肿和啰音计算充血评分（0表示无充血，9表示最大充血）。在100例随机分组的符合条件的患者中，接受泼尼松治疗的患者在第31天充血评分改善更大（在所有患者中，泼尼松组与第31天常规治疗相比的获胜优势比为1.77（95%CI 1.17-2.84；P = 0.0066），在基线IL-6>13 pg/mL的患者中为2.41（95%CI 1.37-5.05；P = 0.0016）。在基线充血评分≥7的患者中，泼尼松治疗对EQ-5D视觉模拟量表评分的影响在第7天为4.30（95%CI 0.77-7.83）分，在第31天为5.40（0.51-10.29）分，与常规治疗相比，心率和呼吸频率更低，血氧饱和度更高。
在AHF和炎症激活的患者中，为期7天的类固醇治疗与至第31天充血体征的减轻相关。这些结果需要在更大规模的研究中得到证实，这些研究将考察类固醇对充血、利尿、液体再分布和血管通透性的潜在影响以及对AHF的临床效果。
