目的:充血是急性心力衰竭结局的主要决定因素。它的评估很复杂,使足够的减充血疗法成为挑战。出院时经常有剩余的拥堵,增加再次住院和死亡的风险。中间区域肾上腺髓质素前反映血管完整性,因此可能是量化充血和指导急性心力衰竭患者充血治疗的客观指标。
结果:观察性,prospective,在未选择的急性心力衰竭患者中进行的单中心研究。本研究旨在评估肾上腺髓质素与充血和临床结果的相关性:院内死亡,根据RELAX-AHF-2试验标准,出院后死亡率和住院心力衰竭恶化。肾上腺髓质素前在基线和出院时定量。应用临床评分评估充血。对具有临床特征校正的Cox和逻辑回归模型进行拟合。N=233,中位年龄77岁(IQR67,83),男性148人(63.5%)。中位肾上腺髓质素前2.0nmol/L(IQR1.4,2.9)。8名患者(3.5%)在医院死亡,100名患者(44.1%)在医院中经历了恶化的心力衰竭。放电后,60例患者(36.6%)在1.92年的中位随访时间内死亡(95%CI:1.76,2.46)。肾上腺髓质素原浓度(对数)与充血显著相关,两者在登记时(β=0.36和0.81,取决于分数,每个P<0.05)和出院时(β=1.12,P<0.001)。肾上腺髓质素前的登记与住院期间心力衰竭恶化相关[OR4.23(95%CI:1.87,9.58),P<0.001],和前肾上腺髓质素在出院时与出院后死亡相关[HR3.93(1.86,8.67),P<0.001]。
结论:肾上腺髓质素前体升高与急性心力衰竭患者住院期间心力衰竭恶化和随访期间死亡相关。需要进一步的研究来验证这一发现,并探索前肾上腺髓质素指导减充血治疗的能力。
OBJECTIVE: Congestion is a major determinant of outcomes in acute heart failure. Its assessment is complex, making sufficient decongestive therapy a challenge. Residual
congestion is frequent at discharge, increasing the risk of re-hospitalization and death. Mid-regional pro-adrenomedullin mirrors vascular integrity and may therefore be an objective marker to quantify
congestion and to guide decongestive therapies in patients with acute heart failure.
RESULTS: Observational, prospective, single-centre study in unselected patients presenting with acute heart failure. This study aimed to assess adrenomedullin\'s association with congestion and clinical outcomes: in-hospital death, post-discharge mortality and in-hospital worsening heart failure according to RELAX-AHF-2 trial criteria. Pro-adrenomedullin was quantified at baseline and at discharge.
Congestion was assessed applying clinical scores. Cox and logistic regression models with adjustment for clinical features were fitted. N = 233, median age 77 years (IQR 67, 83), 148 male (63.5%). Median pro-adrenomedullin 2.0 nmol/L (IQR 1.4, 2.9). Eight patients (3.5%) died in hospital and 100 (44.1%) experienced in-hospital worsening heart failure. After discharge, 60 patients (36.6%) died over a median follow-up of 1.92 years (95% CI: 1.76, 2.46). Pro-adrenomedullin concentrations (logarithmized) were significantly associated with
congestion, both at enrolment (β = 0.36 and 0.81 depending on score, each P < 0.05) and at discharge (β = 1.12, P < 0.001). Enrolment of pro-adrenomedullin was associated with in-hospital worsening heart failure [OR 4.23 (95% CI: 1.87, 9.58), P < 0.001], and pro-adrenomedullin at discharge was associated with post-discharge death [HR 3.93 (1.86, 8.67), P < 0.001].
CONCLUSIONS: Elevated pro-adrenomedullin is associated with in-hospital worsening heart failure and with death during follow-up in patients with acute heart failure. Further research is needed to validate this finding and to explore the ability of pro-adrenomedullin to guide decongestive treatment.