亞洲急性心功能失代償患者死亡風險:B型利尿激素新研究揭示關鍵

本翻譯僅作學術交流用,無商業意圖,請勿轉載,如有疑議問請來信

台灣新研究發現,住院治療急性心功能失代償(ADHF)的亞洲患者中,B型利尿激素(BNP)水平高於100 pg/ml者,其住院死亡風險顯著提高。通過對1807名患者的研究,分析顯示高BNP水平與年齡增大、心衰竭典型症狀、較低的射血分數等因素相關,為臨床治療提供重要預後指標。

在亞洲人口中住院治療的急性心功能失代償的B型利尿激素的使用及其預後影響。

The utilization and prognostic impact of B-type Natriuretic Peptide in hospitalized acute decompensated heart failure in an Asian population

Chen LJ, Hung CL, Yeh HI, Jeng MJ, Su CH, Wu TY, Shih SC, Tsai CH. The utilization and prognostic impact of B-type Natriuretic Peptide in hospitalized acute decompensated heart failure in an Asian population. BMC Cardiovasc Disord. 2016 Sep 9;16(1):178. doi: 10.1186/s12872-016-0342-z. PMID: 27613439; PMCID: PMC5017059.

https://pubmed.ncbi.nlm.nih.gov/27613439/

摘要

背景

住院期間的B型利尿激素(BNP)水平已被證明在心衰竭的診斷中具有預後價值,並進一步預測急性心功能失代償(ADHF)的住院死亡率。此研究描述了住院ADHF的BNP特性,並闡明其在亞洲人群中的住院死亡率的預後價值。

方法

通過回顧醫療記錄,我們連續研究了從2013年3月至2014年3月在台灣北部的三級醫院出院並被診斷為ADHF的20歲以上的患者。使用Cox比例風險迴歸模型評估死亡的預後預測因子。基於目前的臨床實踐標準,將BNP> 100 pg/ml用作定義異常高BNP的臨界值。

結果

實施我們的排除標準後,共有1,807名住院的ADHF患者被研究。與BNP ≤100 pg/ml的受試者相比,BNP較高的個體往往年齡較大,在首次出現時有更多的心衰竭(HF)的典型跡象聚集(例如,外周水腫或肺囉音),較低的射血分數,較低的血紅蛋白水平,更多的生化數據失調,腎功能惡化,住院死亡風險增加兩倍(15.2%對比6.2%,所有p < 0.05)。在多變量分析中,較高的年齡,囉音的出現,更差的紐約心臟協會功能等級,更寬的QRS持續時間和異常的BNP水平(>100 pg/ml)均與考慮到臨床共變數和全球心室射血分數後的住院HF患者死亡率相關(HR:2.17,95%CI:1.15-6.64,p = 0.024)。

結論

在住院期間的ADHF患者中異常高的BNP水平與較差的生理、功能和臨床表現的臨床特徵密切相關,並進一步為確定亞洲人群中的ADHF患者的住院死亡率提供了預後價值。

關鍵詞

急性心功能失代償;B型利尿激素;住院死亡率。

Abstract

Background: B-type natriuretic peptide (BNP) levels during admission have been shown to have prognostic value in the diagnosis of heart failure and further predict the in-hospital mortality of acute decompensated heart failure (ADHF). This study describes the characteristics of BNP among hospitalized ADHF and elucidates its prognostic value of in-hospital mortality in an Asian population.

Methods: We consecutively studied patients aged 20+ who were discharged with a diagnosis of ADHF from March 2013 to March 2014 in a tertiary hospital of northern Taiwan by reviewing medical records. Prognostic predictors of mortality were assessed using Cox proportional hazard regression models. BNP > 100 pg/ml was used as the cut-off for defining abnormally high BNP based on current clinical practice criteria.

Results: After implementation of our exclusion criteria, a total of 1,807 patients hospitalized with ADHF were studied. Compared to those subjects with BNP ≤100 pg/ml, individuals with higher BNP tended to have more advanced age, more clusters of the typical signs of heart failure (HF) (e.g., peripheral edema or lung rales) at presentation, lower ejection fraction, lower hemoglobin levels, more disturbed biochemical data, worsened renal function, and twice the risk for in-hospital mortality (15.2 vs 6.2 %, all p < 0.05). In a multivariate analysis, more advanced age, the presence of rales, a worse New York Heart Association functional class, wider QRS duration, and abnormal BNP levels (>100 pg/ml) were all associated with in-hospital mortality among admitted HF patients after accounting for clinical co-variates and global ventricular ejection fraction (HR: 2.17, 95 % CI: 1.15-6.64, p = 0.024).

Conclusion: Abnormally high BNP levels in ADHF patients during admission were tightly linked to clinical features of worse physical, functional, and clinical presentations, and further provided prognostic value for determining in-hospital mortality among patients with ADHF in an Asian population.

Keywords: Acute decompensated heart failure; B-type natriuretic peptide; In-hospital mortality.

摘要

圖1

圖1 依BNP組別的Kaplan-Meier生存曲線。(對數秩檢定:χ2 = 6.78;p值 = 0.0092)

圖2

圖2 入院BNP水平與住院死亡率的散點平滑圖。

圖3

圖3 BNP四分位數的Kaplan-Meier生存曲線。生存功能的趨勢檢定:卡方 = 11.14;P = 0.0008。

被以下文獻引用

Point-of-care ultrasound modalities in terms of diagnosing acute decompensated heart failure in emergency department; a diagnostic accuracy study.
Farahmand S, Abdolhoseini A, Aliniagerdroudbari E, Babaniamansour S, Baratloo A, Bagheri-Hariri S.
Intern Emerg Med. 2020 Apr;15(3):491-499. doi: 10.1007/s11739-019-02233-x. Epub 2019 Nov 30.
PMID: 31786750
Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications.
Chien SC, Lo CI, Lin CF, Sung KT, Tsai JP, Huang WH, Yun CH, Hung TC, Lin JL, Liu CY, Hou CJ, Tsai IH, Su CH, Yeh HI, Hung CL.
ESC Heart Fail. 2019 Oct;6(5):953-964. doi: 10.1002/ehf2.12501. Epub 2019 Aug 10.
PMID: 31400092 Free PMC article.
2019 Focused Update of the Guidelines of the Taiwan Society of Cardiology for the Diagnosis and Treatment of Heart Failure.
Wang CC, Wu CK, Tsai ML, Lee CM, Huang WC, Chou HH, Huang JL, Chi NH, Yen HW, Tzeng BH, Chang WT, Chang HY, Wang CH, Lu YY, Tsai JP, Su CH, Cherng WJ, Yin WH, Tsai CT, Wu YW, Lin JL, Hwang JJ.
Acta Cardiol Sin. 2019 May;35(3):244-283. doi: 10.6515/ACS.201905_35(3).20190422A.
PMID: 31249457 Free PMC article. Review.