Analysis Of Influencing Factors Of Worsening Renal Function In Patients With Acute Heart Failure And Its Relationship With Events In Vulnerable Period Of Heart Failure

Background and Objectives:The field of heart failure(HF)is a very important part of cardiovascular disease.China has a large population base and a large number of patients with heart failure.With the aging of the population,the incidence of heart failure increases year by year.Acute heart failure(AHF)is the most common cause of hospitalization in patients with heart failure.Studies have shown that the mortality within the vulnerable period of heart failure(within 3 months)and the rate of rehospitalization due to heart failure are higher after discharge.To explore the risk factors of events in the vulnerable period of heart failure is of great significance to judge the patient’s condition,reduce the incidence of events in the vulnerable period and improve the long-term prognosis of patients with heart failure.AHF often coexists with a variety of complications,and renal function damage is closely related to it.It is still controversial whether worsening renal function(WRF)in patients with AHF increases the risk of events in the vulnerable period of heart failure.Therefore,this study explored the incidence and risk factors of WRF in patients with AHF in our center,and whether the complication of WRF led to an increase in the risk of events in the vulnerable period of heart failure.Materials and Methods:Patients admitted to the Department of Cardiology of the second affiliated Hospital of Army Medical University from September 2020 to June 2021 were selected for a retrospective cohort study.A total of 137 patients were included according to the inclusion and exclusion criteria.Collect the clinical data of patients: sex,age,heart rate,systolic blood pressure,diastolic blood pressure,New York Heart Association(NYHA)cardiac function classification,basic medical history and complications,laboratory indicators,echocardiography,the use of heart failure drugs.The patients with AHF were followed up for 3months by telephone follow-up and electronic medical records,and the combined end point events of heart failure were recorded(all due to death or re-hospitalization due to heart failure).The diagnostic criterion of WRF was that the estimated glomerular filtration rate(e GFR)from 5 days after admission to discharge was more than 20% lower than the baseline data.the patients were divided into WRF group and non-WRF group.The differences of baseline data between the two groups were compared.The risk factors of WRF in all patients were analyzed by multivariate Logistic regression,and the line chart model of WRF risk in AHF patients was constructed by R language software(R4.1.0).At the same time,univariate Logistic regression was used to analyze the relationship between WRF and events in the vulnerable period of heart failure.Results:1.A total of 137 patients with AHF were enrolled with an average age of(66.5±13.4)years,80(58.00%)males and 57(42.00%)females.There were 63cases(45.99%)in WRF group,74 cases(54.01%)in non-WRF group,45 patients with CKD(32.85%),54 patients with hypertension(39.42%),28 patients with diabetes(20.44%),91 patients with hyperuricemia(66.42%),63 patients with anemia(45.99%),26 patients with hyponatremia(18.98%)and 19 patients with hypokalemia(13.87%).65 patients(47.45%)died of all causes or re-hospitalized due to heart failure during the vulnerable period,of which 24cases(17.52%)died of all causes and 41 cases(29.93%)were re-hospitalized due to heart failure.2.Comparison of clinical data between WRF group and non-WRF group:patients with NYHA grade IV in WRF group were more than those in non-WRF group(P<0.05).The prevalence rates of chronic kidney disease(CKD),hyperuricemia and hyponatremia in WRF group were higher than those in nonWRF group(P<0.05).Urea,B-type brain natriuretic peptide(BNP),cystatin C and creatinine(Cre)in WRF group were higher than those in non-WRF group(P<0.05).EGFR in WRF group was lower than that in non-WRF group(P<0.05).3.Multivariate Logistic regression analysis showed that CKD(OR: 6.065,P<0.05),hyponatremia(OR: 3.323,P<0.05)and high NYHA grade(OR: 7.796,P<0.05)were independent risk factors for WRF in AHF patients.4.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve of the line chart prediction model for the risk of WRF in AHF patients is 0.825(95% CI 0.757-0.893).The model has high prediction efficiency.The calibration curve is basically distributed along the 45° line,suggesting that the predicted values are in good agreement with the actual observed values.5.Univariate Logistic regression analysis showed that WRF during hospitalization had no significant effect on the occurrence of combined end point events in vulnerable period of AHF patients(P>0.05).Conclusions:1.AHF patients with CKD,hyponatremia and high NYHA grade have an increased risk of WRF.The line chart model constructed in this study is helpful to predict the risk of AHF patients complicated with WRF.2.WRF during hospitalization is not a risk factor for combined end point events in the vulnerable period of heart failure in AHF patients.