Title:Prognostic Significance of Risk Factors and Biomarkers in Patients
Hospitalized for Cardiorenal Syndromes: A Pilot Study
Volume: 30
Issue: 4
关键词:
心肾综合征，心力衰竭，肾脏疾病，维生素D，肾素-血管紧张素-醛固酮系统阻滞剂，慢性功能障碍
摘要:
Background: Cardiorenal syndromes (CRS), involving the heart-kidney
cross-talk and the activation of neurohumoral and inflammatory pathways, are an entity
characterized by high morbidity and mortality.
Objective: To evaluate the prognostic role of risk factors and biomarkers in patients hospitalized
for CRS.
Methods: In this observational cohort study, 100 consecutive patients hospitalized for
CRS were enrolled. Socio-demographic characteristics, personal medical history, and prior
medication use were recorded upon admission, and echocardiography was performed.
Moreover, an array of blood markers were measured. The endpoint of interest was a composite
of death or dialysis dependence at discharge.
Results: Patients were classified into two groups; Group 1 (N= 52): discharged being
dialysis-independent, Group 2 (N=48): death/dialysis dependence at discharge. No significant
differences were detected in baseline characteristics between the two groups. Group
2 patients used renin-angiotensin-aldosterone system blockers (RAASb) less often and
more frequently presented with oliguria/anuria. Group 2 patients had significantly lower
hemoglobin, serum albumin, and 25-hydroxy-vitamin D (25(OH)D). At the same time,
serum phosphate, potassium, and parathyroid hormone (PTH) were significantly higher
in Group 2 patients. In a multivariate regression analysis, lack of prior RAASb and lower
25(OH)D levels were independently associated with an increased risk of death or dialysis
dependence at discharge. 25(OH)D/PTH ratio was the most accurate predictor of the composite
endpoint (Sensitivity: 79.4%, Specificity: 70.4%).
Conclusion: Lack of prior RAASb use, high PTH, low 25(OH)D levels, and low 25(OH)
D/PTH ratio are associated with a poor prognosis in patients hospitalized for CRS.
