心肾综合征5型患者临床特点及死亡危险因素分析
|
摘要
目的探讨心肾综合征5型(cardiorenal syndrome type 5,CRS-5)临床特点及住院全因死亡的危险因素。方法回顾性分析2015年1月—2015年12月同济大学附属同济医院内科病房收治的符合CRS-5诊断的244例患者临床资料,分析临床特点及各项实验室指标;根据患者住院期间是否死亡分为生存组(n=36)和死亡组(n=208)。比较CRS-5患者生存组和死亡组的临床特征和实验室指标,分析独立危险因素。结果 2015年内科病房共收治心肾综合征患者981例。其中CRS-5型244例(26.34%)。CRS-5患者病因中,脓毒症(100例)与糖尿病合并高血压(89例)位居前两位。单因素变量分析结果显示年龄、性别、白细胞计数、血肌酐、肾小球滤过率、糖尿病史、高血压病史、呼吸SOFA、肾脏SOFA等是患者住院死亡危险因素(P<0.05)。Logistic多因素回归分析结果显示年龄、糖尿病史、呼吸SOFA是CRS-5患者死亡独立危险因素。结论脓毒症和糖尿病合并高血压是CRS-5的主要病因,具有较高的死亡率;其中高龄、糖尿病史、高呼吸SOFA评分是CRS-5患者住院死亡的独立危险因素。
Objective To investigate the clinical features and risk factors of hospital mortality in patients with cardiorenal syndrome type 5(CRS-5).Methods The clinical data of 244 patients with CRS-5 admitted in Tongji Hospital,Tongji University from January to December 2015 were analyzed retrospectively.There were 36 patients died(fatal group) during the hospitalization,and 208 were discharged(survival group).The clinical characteristics and laboratory indicators were compared between the survival and fatal groups.Results In 981 patients with cardiorenal syndrome admitted in the same period,244 cases were CRS-5(26.34%),among whom there were 100 cases of sepsis and89 cases of diabetes with hypertension.Univariate analyses showed that the age,sex,the white blood cell count,serum creatinine,e-GFR,history of diabetes,SOFA-respiration score,SOFA-kidney were associated with the hospital mortality.Logistic regression suggested that age,history of diabetes and SOFA-Respiration score were independent prognostic factors of hospital mortality for CRS-5 patients.Conclusion The sepsis and comorbidity of diabetes and hypertension are the leading causes of CRS-5,the mortality is relative high.The age,diabetes history,and SOFA-Respiration score are the independent prognostic factors of hospital mortality for CRS-5 patients.
Objective To investigate the clinical features and risk factors of hospital mortality in patients with cardiorenal syndrome type 5(CRS-5).Methods The clinical data of 244 patients with CRS-5 admitted in Tongji Hospital,Tongji University from January to December 2015 were analyzed retrospectively.There were 36 patients died(fatal group) during the hospitalization,and 208 were discharged(survival group).The clinical characteristics and laboratory indicators were compared between the survival and fatal groups.Results In 981 patients with cardiorenal syndrome admitted in the same period,244 cases were CRS-5(26.34%),among whom there were 100 cases of sepsis and89 cases of diabetes with hypertension.Univariate analyses showed that the age,sex,the white blood cell count,serum creatinine,e-GFR,history of diabetes,SOFA-respiration score,SOFA-kidney were associated with the hospital mortality.Logistic regression suggested that age,history of diabetes and SOFA-Respiration score were independent prognostic factors of hospital mortality for CRS-5 patients.Conclusion The sepsis and comorbidity of diabetes and hypertension are the leading causes of CRS-5,the mortality is relative high.The age,diabetes history,and SOFA-Respiration score are the independent prognostic factors of hospital mortality for CRS-5 patients.
引文
[1]RONCO C,HAAPIO M,HOUSE A A,et al.Cardiorenal syndrome[J].J Am Coll Cardiol,2008,52(19):1527-1539.
[2]FABBIAN F,PALA M,A.DE GIORGI A,et al.Clinical feactures of cardio-renal syndrome in a cohort of consecutive patients admitted to an internal medicine ward[J].Open Cardiovascular Med J,2011,5:220-225.
[3]RONCO C P,MCCULLOUGH S D,ANKER,et al.Cardio-renal syndromes:report from the consensus conference of the acute dialysis quality initiative[J].Eur Heart J,2010,31(6):703-711.
[4]DAMMAN K,VALENTE M A,VOORS A A,et al.Renal impairment,worsening renal function,and outcome in patients with heart failure:an updated meta-analysis[J].Eur Heart J,2014,35(7):455-469.
[5]SONI S S,RONCO C,POPHALE R,et al.Cardiorenal syndrome type 5:epidemiology,pathophysiology,and treatment[J].Semin Nephrol,2012,32(1):49-56.
[6]SHAH H R,SINGH N P,AGGARWAL N P,et al.Cardiorenal syndrome:clinical outcome study[J].JAssoc Physicians India,2016,64(12):41-46.
[7]SHLIPAK,M.G.,R.KATZ,B.KESTENBAUM,et al.Rapid decline of kidney function increases cardiovascular risk in the elderly[J].J Am Soc Nephrol,2009,20(12):2625-2630.
[8]GOLDBERG A,HAMMERMAN H,PETCHERSKIS,et al.Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction[J].Am Heart J,2005,150(2):330-337.
[9]JOSE P,SKALI H,ANAVEKAR N,et al.Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction[J].J Am Soc Nephrol,2006,17(10):2886-2891.
[10]NICHOLS GA G.C.,KORO C E,EPHROSS S A,BROWN J B.The incidence of congestive heart failure intype 2 diabetes:an update[J].Diabetes Care,2004,27(8):1879-1884.
[11]ROSENGREN A,VESTBERG D,SVENSSON A M,et al.Long-term excess risk of heart failure in people with type 1 diabetes:a prospective case-control study[J].The Lancet Diabetes&Endocrinology,2015,3(11):876-885.
[12]MAVRAKANAS T A,KHATTAK A,SINGH K,et al.Epidemiology and natural history of the cardiorenal syndromes in a Cohort with echocardiography[J].Clin J Am Soc Nephrol,2017,12(10):1624-1633.
[13]CHELAZZI C,VILLA G,DE GAUDIO A R,Cardiorenal syndromes and sepsis[J].Int J Nephrol,2011:1-8.
[14]LATINI R,ALEKSOVA A,MASSON S.Novel biomarkers and therapies in cardiorenal syndrome[J].Curr Opin Pharmacol,2016,27:56-61.
[15]DI LULLO L,BELLASI A,BARBERA V,et al.Pathophysiology of the cardio-renal syndromes types 1-5:An update[J].Indian Heart J,2017,69(2):255-265.
[16]BERL T,HENRICH W.Kidney-heart interactions:epidemiology,pathogenesis,and treatment[J].Clin JAm Soc Nephrol,2006,1(1):8-18.
[17]VIRZI G M,CLEMENTI A,BROCCA A,et al.Cardiorenal syndrome type 5 in sepsis:role of endotoxin in cell death pathways and inflammation[J].Kidney Blood Press Res,2016,41(6):1008-1015.
[18]BROCCA A,VIRZI G M,PASQUALIN C,et al.Cardiorenal syndrome type 5:in vitro cytotoxicity effects on renal tubular cells and inflammatory profile[J].Anal Cell Pathol(Amst),2015,:469-478.
[19]MACDONALD S P,ARENDTS G,FATOVICH DM,et al.Comparison of PIRO,SOFA,and MEDSscores for predicting mortality in emergency department patients with severe sepsis and septic shock[J].Acad Emerg Med,2014,21(11):1257-1263.
[2]FABBIAN F,PALA M,A.DE GIORGI A,et al.Clinical feactures of cardio-renal syndrome in a cohort of consecutive patients admitted to an internal medicine ward[J].Open Cardiovascular Med J,2011,5:220-225.
[3]RONCO C P,MCCULLOUGH S D,ANKER,et al.Cardio-renal syndromes:report from the consensus conference of the acute dialysis quality initiative[J].Eur Heart J,2010,31(6):703-711.
[4]DAMMAN K,VALENTE M A,VOORS A A,et al.Renal impairment,worsening renal function,and outcome in patients with heart failure:an updated meta-analysis[J].Eur Heart J,2014,35(7):455-469.
[5]SONI S S,RONCO C,POPHALE R,et al.Cardiorenal syndrome type 5:epidemiology,pathophysiology,and treatment[J].Semin Nephrol,2012,32(1):49-56.
[6]SHAH H R,SINGH N P,AGGARWAL N P,et al.Cardiorenal syndrome:clinical outcome study[J].JAssoc Physicians India,2016,64(12):41-46.
[7]SHLIPAK,M.G.,R.KATZ,B.KESTENBAUM,et al.Rapid decline of kidney function increases cardiovascular risk in the elderly[J].J Am Soc Nephrol,2009,20(12):2625-2630.
[8]GOLDBERG A,HAMMERMAN H,PETCHERSKIS,et al.Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction[J].Am Heart J,2005,150(2):330-337.
[9]JOSE P,SKALI H,ANAVEKAR N,et al.Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction[J].J Am Soc Nephrol,2006,17(10):2886-2891.
[10]NICHOLS GA G.C.,KORO C E,EPHROSS S A,BROWN J B.The incidence of congestive heart failure intype 2 diabetes:an update[J].Diabetes Care,2004,27(8):1879-1884.
[11]ROSENGREN A,VESTBERG D,SVENSSON A M,et al.Long-term excess risk of heart failure in people with type 1 diabetes:a prospective case-control study[J].The Lancet Diabetes&Endocrinology,2015,3(11):876-885.
[12]MAVRAKANAS T A,KHATTAK A,SINGH K,et al.Epidemiology and natural history of the cardiorenal syndromes in a Cohort with echocardiography[J].Clin J Am Soc Nephrol,2017,12(10):1624-1633.
[13]CHELAZZI C,VILLA G,DE GAUDIO A R,Cardiorenal syndromes and sepsis[J].Int J Nephrol,2011:1-8.
[14]LATINI R,ALEKSOVA A,MASSON S.Novel biomarkers and therapies in cardiorenal syndrome[J].Curr Opin Pharmacol,2016,27:56-61.
[15]DI LULLO L,BELLASI A,BARBERA V,et al.Pathophysiology of the cardio-renal syndromes types 1-5:An update[J].Indian Heart J,2017,69(2):255-265.
[16]BERL T,HENRICH W.Kidney-heart interactions:epidemiology,pathogenesis,and treatment[J].Clin JAm Soc Nephrol,2006,1(1):8-18.
[17]VIRZI G M,CLEMENTI A,BROCCA A,et al.Cardiorenal syndrome type 5 in sepsis:role of endotoxin in cell death pathways and inflammation[J].Kidney Blood Press Res,2016,41(6):1008-1015.
[18]BROCCA A,VIRZI G M,PASQUALIN C,et al.Cardiorenal syndrome type 5:in vitro cytotoxicity effects on renal tubular cells and inflammatory profile[J].Anal Cell Pathol(Amst),2015,:469-478.
[19]MACDONALD S P,ARENDTS G,FATOVICH DM,et al.Comparison of PIRO,SOFA,and MEDSscores for predicting mortality in emergency department patients with severe sepsis and septic shock[J].Acad Emerg Med,2014,21(11):1257-1263.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |