心力衰竭患者肾功能恶化与心血管病病死率的关系

Relationship between worsening renal function and cardiovascular mortality in patients with heart failure

目的评估失代偿性心力衰竭(HF)患者的肾功能恶化(WRF)与长期心血管病病死率的关系。方法回顾性研究2010年3月—2016年3月在天津中医药大学第一附属医院治疗的301例失代偿性HF患者。血清肌酐(Scr)相对增加>25%或Scr较基线增加≥0.3mg/dl即为WRF。评估有WRF(WRF组)和无WRF(非WRF组)的HF患者的心血管病病死率和全因死亡率。结果118例(39.2%)患者出现WRF,平均随访537d,WRF组心血管病病死率和全因死亡率高于非WRF组(P<0.05)。多因素Cox比例风险模型分析结果显示,年龄和血浆B型利钠肽水平都与心血管病病死和全因死亡相关(P<0.05),但WRF不是心血管病病死和全因死亡的预测因子(P>0.05)。结论WRF与HF患者的心血管病病死相关。尽管WRF不是心血管病病死的预测因子,但是WRF可能是预测患者出院后是否需要随访的重要指标之一。

Objective To evaluate the relationship of worsening renal function (WRF) and cardiovascular mortality in patients with heart failure (HF). Methods Decompensated HF patients admitted to our constitution between April 2010 and March 2016 were enrolled in this study. WRF was defined as serum creatinine relatively increased at least 25% or serum creatinine increased levels ≥0.3 mg/dL from the baseline. The cardiovascular mortality and all-cause mortality in HF patients were assessed in WRF (WRF group) and non-WRF (non-WRF group). Results Among 301 patients included, WRF occurred in 118 patients (39.2%). During a median followup period of 537 days, compared with the non-WRF group, cardiovascular mortality and all-cause mortality were significantly higher in the WRF group (P < 0.05). Multivariate Cox proportional hazards model analysis results showed that age and serum B-type natriuretic peptide (BNP) level were associated with both cardiovascular death and all-cause death. But, WRF was not the independent predictor of cardiovascular death and all-cause death. Conclusions WRF is associated with cardiovascular death in patients with HF. Although WRF is not an independent predictor for cardiovascular death, it may be one of useful markers to identify whether patients be followed carefully or not after discharge.