背景:区分心力衰竭(HF)诱导的肾功能不全(RD)与内在肾脏疾病是具有挑战性的。已经证明,生物标志物如B型利钠肽(BNP)或血尿素氮与肌酐之比(BUN/creat)可以识别高风险和低风险RD。我们的目的是确定结合这些生物标志物是否可以进一步改善RD和HF患者的风险分层和临床表型。
结果:共纳入908例出院诊断为心力衰竭的患者。中值用于定义升高的BNP(>1296pg/mL)和BUN/creat(>17)。在没有RD的组中,无论BNP和BUN/creat如何,生存率相似(n=430,校正P=0.52).同样,在BNP和BUN/creat均较低的患者中,RD与死亡率无关(n=250,校正风险比[HR]=1.0,95%置信区间[CI]0.6-1.6,P=.99)。然而,在BNP和BUN/creat均升高的患者中,RD患者的心肾特征以静脉充血为特征,利尿剂抵抗,低血压,低钠血症,停留时间较长,更大的Inotrope使用,与没有RD的患者相比,生存率明显更差(n=249,调整后的HR=1.8,95%CI1.2-2.7,P=.008,P交互作用=.005)。
结论:在失代偿性HF的情况下,联合使用BNP和BUN/creat将RD患者分为临床表型和预后显著不同的组.
BACKGROUND: Differentiating heart failure (HF) induced renal dysfunction (RD) from intrinsic kidney disease is challenging. It has been demonstrated that biomarkers such as B-type natriuretic peptide (BNP) or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk RD. Our objective was to determine if combining these biomarkers could further improve risk stratification and clinical phenotyping of patients with RD and HF.
RESULTS: A total of 908 patients with a discharge diagnosis of HF were included. Median values were used to define elevated BNP (>1296 pg/mL) and BUN/creat (>17). In the group without RD, survival was similar regardless of BNP and BUN/creat (n = 430, adjusted P = .52). Similarly, in patients with both a low BNP and BUN/creat, RD was not associated with mortality (n = 250, adjusted hazard ratio [HR] = 1.0, 95% confidence interval [CI] 0.6-1.6, P = .99). However, in patients with both an elevated BNP and BUN/creat those with RD had a cardiorenal profile characterized by venous congestion, diuretic resistance, hypotension, hyponatremia, longer length of stay, greater inotrope use, and substantially worse survival compared with patients without RD (n = 249, adjusted HR = 1.8, 95% CI 1.2-2.7, P = .008, P interaction = .005).
CONCLUSIONS: In the setting of decompensated HF, the combined use of BNP and BUN/creat stratifies patients with RD into groups with significantly different clinical phenotypes and prognosis.