| Background and ObjectiveAcute heart failure(AHF)is a clinical syndrome involving multiple organs and neurohumoral systems.With the rapid development of medical undertakings,the incidence rate and mortality rate of AHF is still high.Effective screening of high-risk patients with future adverse events will help guide the medical decision-making in AHF patient management.Although a large number of studies have reported the influence of serum markers on AHF patients,there are few studies on the value of prognosis related indicators.Renal function deterioration(WRF)often occurs in patients with acute heart failure(AHF),but its prognostic value for AHF is not clear.Blood urea nitrogen(BUN)is not only a marker of renal function,but also reflects the strength of neurohormone activity and vasopressin(AVP)reabsorption of urea in distal tubules.Therefore,the fluctuation of bun or the change of renal function can be used as an indicator to know when the relative decrease of intravascular volume occurs in patients with heart failure.Through this study,we studied the relationship between the change of bun and WRF and the prognosis of AHF patients.Materials and methods1.Participants:from June 2018 to December 2018,patients with acute heart failure who were treated in the cardiology department of the Second Affiliated Hospital of Zhengzhou University were collected as samples.Inclusion criteria:(1)the first diagnosed patients with acute heart failure(in accordance with the guidelines for the diagnosis and treatment of acute heart failure jointly issued by the Chinese society of Cardiology and the editorial board of Chinese Journal of Cardiology,and confirmed by 2 or more clinicians);(2)the patients themselves knew and agreed.Exclusion criteria:(1)end-stage renal disease(serum creatinine>442 umol/L or renal replacement therapy(dialysis or ultrafiltration));(2)recent myocardial infarction(within 30 days after screening).2.Grouping method:?bun increase?20%and WRF combination ?bun increase? 20%and WRF combination ? bun increase<20%and WRF combination?bun increase<20%and WRF combination(control group).(WRF is defined as the increase of serum creatinine?26.5umol/l or the decrease of estimated glomerular filtration rate(EGFR)?20%in hospitalized patients.An increase in bun was defined as an increase in bun?20%during admission.HF symptomatic remission is defined as the complete resolution of two or more clinical symptoms of HF.)3.Statistical analysis:SPSS 20.0 statistical software was used for statistical analysis.The measurement data conforming to the normal distribution are expressed in((?)),and the t-test is used for group comparison;the measurement data not conforming to the normal distribution are expressed in the median(interquartile spacing)[(QR)],and the Wilcoxon rank sum test is used for group comparison;the measurement data are expressed in the relative logarithm,and the ? 2 test is used for group comparison;the linear trend test is used for orderly grouping data Test;Taking the follow-up time and survival outcome(death and rehospitalization due to heart failure as the combined outcome)as the dependent variables,the Cox proportional risk regression model was used to correct the confounding factors(such as age,gender,hypertension,diabetes,dyslipidemia,coronary heart disease,chronic kidney disease and smoking habits),and then the four groups were compared.The risk ratio(HR)and 95%confidence interval(CI)of the other three groups were calculated with reference to the control group.The Kaplan Meier survival curves of each group were drawn,and the log rank method was used to compare the differences among the survival curves.Result(1)During a follow-up of 180 days after discharge,109(52%)patients died or were hospitalized for acute heart failure.In the single factor Cox analysis,the increase of BUN?20%and the occurrence of WRF compared with the increase of BUN<20%and did not occur WRF,which were the risk factors of poor prognosis;in the multi factor Cox analysis,the increase of BUN?20%and the occurrence of WRF were still the risk factors of poor prognosis,that is to say,the increase of BUN?20%and WRF were both the poor risk factors of prognosis in patients with acute heart failure.Further analysis of the data shows that the increase of BUN? 20%without WRF is still an adverse risk factor for the prognosis of patients with acute heart failure(single factor Cox analysis HR 2.44(1.56-3.83),P=0.018;multivariate Cox analysis HR 2.11(1.42-3.21),P=0.018),so the increase of BUN>20%is an independent risk factor for the prognosis of patients with acute heart failure,and has nothing to do with the occurrence of WRF.Data analysis also showed that if BUN did not increase by more than 20%,WRF could not be used as an independent risk factor for the prognosis of acute heart failure(single factor Cox analysis HR 1.89(0.98-3.62),P=0.110;multivariate Cox analysis HR 1.77(0.81-2.93),P=0.170).(2)In order to evaluate the effect of clinical congestive symptoms on the prognosis of patients with acute heart failure,we divided the selected patients into four groups according to the increase of BUN?20%and the remission of HF symptoms at discharge:group A:the increase of BUN? 20%and no HF remission;group B:the increase of BUN?20%and HF remission;group C:the increase of BUN<20%and no HF remission;group D:the increase of BUN<20%and HF remission.Data analysis showed that:in single factor Cox analysis,the increase of BUN>20%and HF free remission compared with the increase of BUN<20%and HF remission was the risk factor of poor prognosis;in multi factor Cox analysis,BUN>20%and HF free remission were still the risk factors of poor prognosis.Further analysis of the data shows that the increase of BUN?20%is still a risk factor for the prognosis of patients with acute heart failure when HF is relieved(single factor Cox analysis HR 2.46(1.27-4.77),P=0.009;multivariate Cox analysis HR 2.23(1.39-3.06),P=0.021),so the increase of BUN?20%is an independent risk factor for the prognosis of patients with acute heart failure,regardless of whether HF is relieved or not.Data analysis also showed that if BUN does not increase by more than 20%,HF remission or not can not be regarded as an independent risk factor for prognosis of acute heart failure(single factor Cox analysis HR 1.97(0.71-3.73),P=0.231;multi factor Cox analysis HR 1.68(0.84-2.66),P=0.143).ConclusionDuring the hospitalization of patients with acute heart failure,if the increase of blood urea nitrogen(BUN)is more than 20%,regardless of the change of renal function or the improvement of clinical congestive symptoms during this period,it indicates that the incidence of adverse prognosis of patients with acute heart failure after discharge is high,so the increase of BUN is more than 20%as an independent risk factor for prognosis of patients with acute heart failure.However,the results also show that the occurrence of WRF during hospitalization in patients with acute heart failure is not an independent risk factor for prognosis,and the remission of clinical congestion symptoms is not an independent risk factor for prognosis. |
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