CKD-EPI胱抑素C公式对高龄急性心力衰竭患者的预后价值

Prognostic Value of CKD-EPI Cystatin C Formula in Elderly Patients With Acute Heart Failure

目的探讨基于胱抑素C(cystatin C,CysC)的慢性肾脏病流行病学协作公式(the chronic kidney disease epidemiology collaboration equation,CKD-EPI)估算肾小球滤过率在高龄急性心力衰竭(acute heart failure,AHF)患者中的预后价值。方法选取2020年1月—2022年6月福建省老年医院收治的106例AHF住院患者,完善经胸心脏彩超、N末端脑钠肽前体、肌酐、CysC等指标,通过内生肌酐清除率公式(creatinine clearance rate,Ccr)、中国改良的简化肾脏病饮食改良研究公式(the modification of diet in renal disease equation,MDRD)、CKD-EPI肌酐公式(CKD-EPI creatinine formula,eGFRscr)、CKD-EPI胱抑素C公式(CKD-EPI cystatin C formula,eGFRcysc)和CKD-EPI肌酐-胱抑素C公式(CKD-EPI creatinine-cystatin C formula,eGFRscr-cysc)估算eGFR。患者出院后每3个月随访1次,共随访12个月,终点事件为心力衰竭失代偿再入院和心源性死亡。结果事件组与非事件组eGFRcysc、eGFRscr-cysc比较,差异有统计学意义(P<0.05)。基于CysC的CKD-EPI公式肾功能不全比例较高。Logistic分析提示,eGFRcysc、eGFRscr-cysc是AHF患者12个月内发生心血管事件的独立预测因子。其中eGFRcysc在心血管事件预测价值最高,曲线下面积(area under curve,AUC)为0.759,最佳截点31.96 mL/(min·1.73 m^(2))。结论基于CysC的eGFRcysc公式对高龄AHF患者1年内不良心血管事件有很高的预测价值。

Objective To investigate the prognostic value of cystatin C(CysC)-based the chronic kidney disease epidemiology collaboration equation(CKD-EPI)formula for estimating glomerular filtration rate in elderly patients with acute heart failure(AHF).Methods A total of 106 patients with AHF admitted to Fujian Provincial Geriatric Hospital from January 2020 to June 2022 were selected,and improved the indexes of transthoracic heart color ultrasound,N-terminal brain natriuretic peptide precursor,creatinine,CysC,etc.eGFR was estimated by creatinine clearance rate(Ccr),sinicized the modification of diet in renal disease equation(MRDR),CKD-EPI creatinine formula(eGFRscr),CKD-EPI cystatin C formula(eGFRcysc),and CKD-EPI creatinine-cystatin C formula(eGFRscr-cysc).Patients were followed up every 3 months after discharge for 12 months.The end events were decompensated hospital readmission and cardiac death.Results There were significant differences in eGFRcysc and eGFRscr-cysc between event group and non-event group(P<0.05).The CKD-EPI formula based on cystatin C had a higher rate of renal insufficiency.Logistic analysis suggested that eGFRcysc and eGFRscr-cysc were independent predictors of cardiovascular events within 12 months in patients with AHF.eGFRcysc has the highest predictive value in cardiovascular events,with area under curve(AUC)of 0.759 and an optimal cut-off point of 31.96 mL/(min·1.73 m^(2)).Conclusion The eGFRcysc formula based on cystatin C has a high predictive value for adverse cardiovascular events within 1 year in elderly patients with acute heart failure.