Analysis Of Related Factors Of Worsening Renal Function in Patients With Ischemic Heart Failure

Abstract:

Aim To explore the characteristics of renal function changes in patients with ischemic heart failure (HF) during hospitalization. Methods Patients with ischemic HF hospitalized in the Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University from October 2013 to December 2017 were retrospectively included. Descriptive statistics was used to describe the baseline clinical features of patients. A multivariate Logistic regression model was used to explore the related factors of worsening renal function (WRF) in ischemic HF patients. Results 797 patients with ischemic HF were enrolled in this study, with an average age of (70. 5 ±11. 1) years, of whom 68. 9% was male. Among them, 22. 5% was HF patients with reduced left ventricular ejection fraction (LVEF) and 57. 6% was HF patients with retained LVEF. The incidence of WRF was 18. 4% . The related factors leading to WRF included high serum creatinine (OR = 1. 953, P<0. 001), history of hypertension (OR = 1. 859, P = 0. 025), low hemoglobin (OR =0. 985, P= 0. 002), high fibrinogen (OR = 1. 241, P = 0. 013), high blood chlorine (OR = 1. 042, P=0. 049),high blood uric acid (OR= 1. 002, P= 0. 039) and using furosemide (OR = 1. 773, P = 0. 033).

Conclusion The incidence of WRF in ischemic HF patients is high, and there are many related factors; Clinically, it is necessary to pay attention to the changes of patients' renal function and control-related factors in time, especially low hemoglobin, high fibrinogen, high blood chlorine and high blood uric acid.

 

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[KEY WORDS] ischemic heart failure; worsening renal function; related factor

 

Heart failure (HF) is a severe manifestation and late stage of various heart diseases, and its prevalence increases with age [1]. With the progress of population aging in our country, HF will still be one of the difficulties that my country's medical and health undertakings need to overcome for a considerable period of time in the future. The etiology of HF is diverse, including cardiomyopathy, abnormal cardiac load, arrhythmia, etc.[2]. Among them, coronary heart disease is one of the most common causes of HF, and HF caused by coronary heart disease (especially ischemic cardiomyopathy) is also called ischemic HF[3].
HF patients are often combined with renal impairment, and the prevalence of renal insufficiency in HF patients is about 50%[4]. In order to more sensitively detect renal function damage in hospitalized HF patients, it is often reflected by worsening renal function (WRF), which is defined as an increase in serum creatinine ≥ 26.5 μmol/L from baseline during hospitalization [5]. In previous studies, factors related to WRF in patients with acute HF include advanced age, male sex, renal insufficiency, diabetes, high or low systolic blood pressure, atrial fibrillation, hyponatremia, high dose of furosemide, etc.[5]. At present, there are few studies on the ischemic HF population, and no research has explored the related factors of WRF in patients with ischemic HF. This study intends to explore the clinical characteristics of patients with ischemic HF and the related factors of WRF, so as to provide more information for the clinical diagnosis, treatment and scientific research of ischemic HF.

 

1 Materials and methods
1.1 Research object
This study is a retrospective study, and the patients with ischemic HF hospitalized in the Department of Cardiology of the First Affiliated Hospital of Sun Yat-sen University from October 2013 to December 2017 were screened according to the inclusion and exclusion criteria. The diagnostic criteria of HF refer to the "Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2014" [6], and ischemic HF is defined as HF with coronary heart disease as the etiology [3]. Inclusion criteria: (1) patients aged ≥18 years; (2) consistent with the diagnosis of ischemic HF; (3) complete medical history, laboratory examination, imaging examination and medication information during hospitalization. Exclusion criteria: (1) associated with malignant tumors; (2) associated with severe infection (sepsis); (3) associated with severe liver insufficiency (alanine aminotransferase exceeding 10 times the upper limit of normal value); (4) medical history and laboratory tests , Imaging examination and medication data during hospitalization were missing. The study complied with the Declaration of Helsinki.

1.2 Collection of clinical data
The clinical data of patients were collected from the hospital information system, including age, gender, history of diabetes, history of hypertension, history of atrial fibrillation, and physical examination (heart rate, systolic blood pressure, diastolic blood pressure) from admission records; During the blood test, N-terminal pro-B-type natriuretic peptide precursor (N-terminal pro-B-type natriuretic peptide, NT-proBNP), cardiac troponin T (cardiac troponin T, cTnT), hemoglobin, hematocrit, White blood cell count, neutrophil ratio, platelet count, prothrombin time, activated partial thromboplastin time, international normalized ratio, D-dimer, fibrinogen, osmotic pressure, blood sodium, blood potassium, blood chloride, Serum creatinine, blood urea nitrogen, random blood glucose, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum albumin, total cholesterol, low density lipoprotein cholesterol (low density lipoprotein cholesterol, LDLC), high density Lipoprotein cholesterol (high density lipoprotein cholesterol, HDLC), blood uric acid; left ventricular ejection fraction (left ventricular ejection fraction, LVEF) was collected from the first echocardiographic examination within 24 hours of admission; Collect medication records, such as intravenous and oral furosemide, spironolactone, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blockade (angiotensin receptor blockade, ARB), β receptor blocker statins, amiodarone, digoxin. In addition, all blood creatinine records during hospitalization were also collected from blood tests to evaluate whether patients developed WRF.

1.3 Statistical analysis
Continuous variables conforming to normal distribution are represented by x±s, and differences between groups are compared using independent sample t test; continuous variables that do not conform to normal distribution are represented by median and quartile, and differences between groups are compared using Wilcoxon rank sum test. Categorical variables were expressed as the number of cases and percentages, and chi-square test or Fisher's exact test were used to compare differences between groups. Variables with statistically significant differences in comparison between groups (continuous variables that do not conform to the normal distribution were logarithmically transformed to the base of 2) were included in the multivariate Logistic regression model, and the factors related to the occurrence of WRF were explored using the backward method . Statistical analysis was performed using SPSS 26.0 software. Two-sided P<0.05 was considered statistically significant.

2 results
2.1 Baseline clinical data of patients with ischemic HF A total of 797 patients with ischemic HF were included in this study, and the baseline clinical data are shown in Table 1. The average age of the subjects was (70. 5±11. 1) years old, and 68. 9% were male. The median LVEF of patients was 54%. According to the HF classification standard, 22.5% were HF patients with reduced LVEF, and 57.6% were HF patients with preserved LVEF. In terms of complications, 44.7% of patients were complicated with diabetes mellitus, 70.8% were complicated with hypertension, and 17.8% were complicated with atrial fibrillation. In terms of physical examination, the average heart rate of the patients was 80.1 beats/min, the average systolic blood pressure was 130.6 mmHg, and the average diastolic blood pressure was 74.5 mmHg. In terms of laboratory tests, the median NT-proBNP of patients admitted to the hospital was 2 524. 0 ng / L, the median cTnT was 0. 044 μg / L, the median serum creatinine was 106 μmol / L, and the average total cholesterol was 4. 20 mmol / L. L, average LDLC 2. 64 mmol / L. During hospitalization, 80.9% of patients used ACEI/ARB, 91.5% used beta-blockers, 63.7% used spironolactone, and 98.1% used statins. In addition, 68. 4% of the patients used furosemide orally, 47. 8% of the patients used furosemide intravenously, 21. 3% of the patients used digoxin, and 9. 4% of the patients used amiodarone.

Table 1. Baseline clinical data of 797 patients with ischemic HF