老年患者急性心肾综合征的危险因素及预后分析

Risk factors and prognosis of acute cardiorenal syndrome in elderly patients

目的对老年急性心肾综合征(acute cardiorenal syndrome,ACRS)患者的危险因素及预后进行分析。方法回顾性分析312例住院期间发生急性心力衰竭(acute heart failure,AHF)的老年患者的临床资料[其中164例合并急性肾损伤(acute kidney injury,AKI)(ACRS组),148例未合并AKI(非ACRS组)]。结果 312例AHF患者中,13.1%住院期间死亡,Charlson并发症评分≥3分、住院期间发生ACRS和住院期间需要透析治疗是AHF患者死亡的危险因素(OR=4.723,P=0.041;OR=6.096,P=0.008;OR=18.743,P<0.001)。52.56%的AHF患者发生ACRS,估算肾小球滤过滤(estimated glomerular filtration,eGFR)<60 mL/(min·1.73 m2)、使用利尿药是AHF患者住院期间发生ACRS的危险因素(OR=2.239,P=0.025;OR=2.555,P=0.001);eGFR、血清白蛋白(albumin,ALB)是AHF患者住院期间发生ACRS的保护因素(OR=0.968,P<0.001;OR=0.907,P=0.007)。23.2%的ACRS患者死亡,住院期间透析是ACRS患者住院期间死亡的危险因素(OR=10.407,P<0.001);使用β受体阻断药、使用利尿药是ACRS患者住院期间死亡的保护因素(OR=0.312,P=0.011;OR=0.345,P=0.040)。结论老年患者ACRS发生率高、预后差。基础eGFR和ALB浓度降低以及使用利尿药可能使老年AHF患者发生ACRS的风险增加。并发症多、住院期间发生ACRS、住院期间需要透析治疗均是老年AHF患者不良预后的危险因素。

Objectives To investigate the risk factors and the prognosis of acute cardiorenal syndrome （ACRS） in elderly patients.Methods This research retrospectively analyzed the clinical data of 312 elderly patients （age ≥ 60 years） with acute heart failure （AHF） [164 of them were accompanied with acute kidney injury （AKI） （ACRS group）,while the other 148 cases were not （N ACRS group）].Results The in-hospital mortality of the 312 patients with AHF was 13.1%.Higher Charlson comorbidity index （CCI score ≥3）,occurrence of ACRS and dialysis were risk factors for inhospital mortality in AHF patients （OR=4.723,P=0.041 ; OR=6.096,P=0.008; OR=18.743,P〈0.001; respectively）.Incidence of ACRS was 52.56%.Basic estimated glomerular filtration （eGFR） 〈60 mL/（min· 1.73 m2） and use of diuretics were both associated with the higher risk of ACRS in patients with AHF （OR=2.239,P=0.025 ; OR=2.555,P=0.001 ; respectively） ; while higher basic eGFR and serum concentration of albumin were both protective factors for ACRS （OR =0.968,P〈0.001; OR =0.907,P=0.007; respectively）.There were 23.2% ACRS patients died during hospitalization.Dialysis was the risk factor for in-hospital mortality in ACRS patients （OR=10.407,P〈0.001）,while use of β-blockers and diuretics displayed as protective factors （OR =0.312,P=0.011 ; OR =0.345,P=0.040 ; respectively）.Conclusions Incidence of ACRS in elderly patients with AHF is relative high and significantly associated with poor outcome.Reduced basic eGFR,serum albumin and use of diuretic are predictors of occurrence of ACRS,while higher Charlson comorbidity index,incidence of ACRS and dialysis are associated with higher risk of in-hospital mortality in patients with AHF.