| Objective: To explore the value of serum creatinine,urea nitrogen,uric acid levels and their changes after discharging from hospital about 1month in patients with chronic heart failure.Methods:1.This research collected 433 patients from the Department of Cardiology of our hospital,date from 2017-02-01 to 2018-02-28,age from 18 to 85 years old.All patients had no communication disorder and enrolled in the prospective cohort study of China-Peace5 heart failure.2.Baseline datas of patients were recorded: gender,age,height,weight,heart rate,blood pressure,body temperature,past history,personal history,liver and kidney function,NT-proBNP,LVEF,6-minute walking test,etc.According to their symptoms and signs,the patients were devided into three groups: Groups ?,?,and ? through the NYHA heart function classification.3.All patients were followed for one-year telephone or outpatient visits,including one visit at the first month and another at twelfth months after discharging.In the first review,we complete the test of serum creatinine,serum urea nitrogen,serum uric acid and end points(readmission caused by heart failure,cardiovascular death,cardiovascular surgery: PCI or coronary artery bypass grafting,valve replacement surgery,acute renal insufficiency,all-cause death,etc.).Also we recorded end points in the second review.4.SPSS25.0 software was used to analyze the relationship between factors at admission and NYHA classification and one year advers events after discharge,the predictive value of changes in serum creatinine,urea and uric acid levels one month after discharge for one year end points.Results:1.433 patients with chronic heart failure were enrolled,288 males and 145 females,complications included 119 atrial fibrillation,203 hypertension,67 diabetes mellitus and 144 anemia.There are 78 cases with NYHA function grade ?,231 cases with grade ?,124 cases with grade ?.Rank sum test and K-samples non-parametric test(Kruskal-Wallis H)showed that: There were no significant differences in gender,age,BMI,SBP,DBP,heart rate,body temperature,complications(atrial fibrillation,diabetes,anemia,hypertension)among the three groups with different NYHA grades,but there were significant differences in serum creatinine,urea,uric acid,NT-proBNP,LVEF and6 MWT.Ordered logistic regression analysis showed that serum NT-proBNP and uric acid were independent risk factors for the severity of chronic heart failure.2.433 patients were followed up for one year,Chi-square test and Kruskal-Wallis H test found that: gender,age,BMI,SBP,DBP,heart rate,body temperature,complications(atrial fibrillation,diabetes,anemia,hypertension),serum creatinine levels were not associated with end points in one years.Serum urea nitrogen,uric acid,NT-proBNP,6MWT and LVEF may be related factors of end points of chronic heartfailure.The binary logistic regression analysis of 178 patients who attended outpatient follow-up one month after discharged showed that:The increase of blood urea nitrogen by more than 20% in 1 month after discharge than that during hospitalization was an independent risk factor for one-year end points in patients with chronic heart failure(P=0.008,OR=5.252,95% CI 1.542-17.893).The occurrence of one-year end points was 5.583 times higher than that in patients without increase of serum urea nitrogen.Conclusion:1.Serum NT-proBNP and uric acid were independent risk factors for the severity of chronic heart failure at admission.2.The increase of serum urea nitrogen in patients with chronic heart failure in one month after discharge is an independent risk factor for one-year end points in one year after discharge. |
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