目的:肾功能恶化(WRF)是急性心力衰竭(AHF)的常见并发症,具有有争议的预后价值。我们的目的是研究钠尿对评估WRF的有用性。
方法:我们进行了一项观察,prospective,接受呋塞米压力测试的AHF患者的多中心研究。根据是否存在WRF并根据中位利钠反应对患者进行分类。主要终点是死亡率的组合,因HF再住院,和心脏移植在6个月的随访。
结果:纳入了156名患者,和WRF发生在60(38.5%)。将患者分为4组:a)47(30.1%)无WRF/低UNa(UNa≤109mEq/L);b)49(31.4%)无WRF/高UNa(UNa>109mEq/L);c)31(19.9%)WRF/低UNa和d)29(18.6%)WRF/高UNa。WRF/低UNa组的参数显示出更高的临床严重程度以及更差的利尿和减充血反应。WRF的发展与合并事件的高风险相关(HR,1.88;95CI,1.01-3.50;P=.046)。当通过利钠反应分层时,WRF与低钠尿症患者的不良事件风险增加相关(HR,2.28;95CI,1.15-4.53;P=.019),但在高钠尿症患者(HR,1.18;95CI,0.26-5.29;P=.826)。
结论:利尿可能是解释和预测AHF中WRF的有用生物标志物。WRF仅在低钠尿的情况下与较高的不良事件风险相关。
OBJECTIVE: Worsening renal function (WRF) is a frequent complication in acute heart failure (AHF) with a controversial prognostic value. We aimed to study the usefulness of
natriuresis to evaluate WRF.
METHODS: We conducted an observational, prospective, multicenter study of patients with AHF who underwent a furosemide stress test. The patients were classified according to whether WRF was present or absent and according to the median natriuretic response. The main endpoint was the combination of mortality, rehospitalization due to HF, and heart transplant at 6 months of follow-up.
RESULTS: One hundred and fifty-six patients were enrolled, and WRF occurred in 60 (38.5%). The patients were divided into 4 groups: a) 47 (30.1%) no WRF/low UNa (UNa ≤ 109 mEq/L); b) 49 (31.4%) no WRF/high UNa (UNa > 109 mEq/L); c) 31 (19.9%) WRF/low UNa and d) 29 (18.6%) WRF/high UNa. The parameters of the WRF/low UNa group showed higher clinical severity and worse diuretic and decongestive response. The development of WRF was associated with a higher risk of the combined event (HR, 1.88; 95%CI, 1.01-3.50; P = .046). When stratified by natriuretic response, WRF was associated with an increased risk of adverse events in patients with low
natriuresis (HR, 2.28; 95%CI, 1.15-4.53; P = .019), but not in those with high
natriuresis (HR, 1.18; 95%CI, 0.26-5.29; P = .826).
CONCLUSIONS: Natriuresis could be a useful biomarker for interpreting and prognosticating WRF in AHF. WRF is associated with a higher risk of adverse events only in the context of low
natriuresis.