住院心力衰竭患者院内收缩压变化与预后的相关性

Association between the change of systolic blood pressure during hospitalization and the prognosis in hospitalized patients with heart failure

目的:探讨入院收缩压偏低(<120mmHg,1mmHg=0.133kPa)的心力衰竭(心衰)患者院内收缩压变化与出院后预后的相关性。方法:回顾性入选2009-04-2015-01月于阜外医院心力衰竭中心住院且入院时收缩压低于120mmHg的心衰患者。采用出院收缩压减去入院收缩压的差值作为院内收缩压变化值(△SBP),随访1年及3年全因死亡事件,比较不同△SBP水平之间终点事件的发生率是否存在差异,并采用多因素Cox回归模型分析临床结局风险与△SBP水平的相关性。结果:共有592例患者纳入分析,以-10mmHg为界值将△SBP分为两组:△SBP<-10mmHg组,118例(19.9%);△SBP≥-10mmHg组,474例(80.1%)。△SBP<-10mmHg组1年全因死亡率高于△SBP≥-10mmHg组(29.7%∶16%,P<0.01)。两组3年全因死亡率差异无统计学意义(41.5%∶34.4%,P>0.05)。在校正年龄、NYHA心功能分级、出院心率、肾功能不全等因素后,△SBP<-10mmHg组患者的1年全因死亡风险高于△SBP≥-10mmHg组患者全因死亡风险(HR=1.805,95%CI:1.200～2.714,P<0.01)。结论:入院收缩压偏低的心衰患者,院内血压下降程度具有重要的临床意义。出院时收缩压水平较入院时下降超过10mmHg与出院后预后不良有相关性。

Objective:To investigate the association between the change of systolic blood pressure(SBP)during hospitalization and the prognosis after discharge in heart failure patients with a relatively low SBP(<120mmHg,1mmHg=0.133kPa)at admission.Method:Patients with heart failure and SBP at admission less than 120 mmHg,hospitalized in the heart failure center of Fuwai Hospital during April 2009 to January 2015 were respectively enrolled.The change of SBP during hospitalization(△SBP)was calculated by subscribing the admission SBP values from the discharge values.All-cause mortality at 1 year and 3 years were recorded during the follow up period and compared among patients with different△SBP levels.The association between the△SBP level and clinical outcomes was analyzed using multivariable Cox regression hazard model.Result:A total of 592 patients were included and divided into two groups according to the△SBP level,including△SBP<-10 mmHg group(n=118)(19.9%)and △SBP≥-10 mmHg group(n=474)(80.1%).All-cause mortality at 1 year was higher in the△SBP<-10 mmHg group than those in the△SBP≥-10 mmHg group(29.7% vs.16%,P<0.01).There was no significant statistical difference in the all-cause mortality at 3 years(41.5% vs.34.4%,P>0.05)between the two groups.After adjusted the age,heart rate at discharge,NYHA class and renal function in the multivariable Cox regression hazard model,we found the adjusted risk of 1 year all-cause mortality in the△SBP<-10 mmHg group was approximate twice higher than those in the△SBP≥-10 mmHg group(HR=1.805,95%CI:1.200-2.714,P<0.01).Conclusion:The change of blood pressure during hospitalization has important clinical implications in the management of heart failure patients with a relatively low SBP at admission.SBP value decrease more than 10 mmHg during hospitalization is associated with adverse outcomes in the post-discharged prognosis.