关键词: 连续性血液滤过, 心肾综合征, 住院死亡率, 血清肌酐

Abstract: 【Abstract】 Objectives We aimed to investigate the efficacy of continuous hemofiltration in patients with cardiorenal syndrome, to assess the factors affecting their prognosis, and thus to help us optimally select patients who can benefit more from this therapy. Methods Forty-nine patients with cardiorenal syndrome treated with continuous hemofiltration were enrolled in this study. To retrospectively analyze the factors affecting mortality, we collected their clinical data including results from laboratory and instrument examinations, and continuous hemofiltration parameters, and divided them into two groups based on survival or death during hospitalization. Results There were 30 cases in the survival group, and 29 cases in the death group. The results with statistical differences between the survival group and the death group are as follows: (a) biochemical parameters before continuous hemofiltration including serum creatinine (411.123±239.847 vs. 270.393±150.719 μmol/L, P=0.009), serum total bilirubin (10.824±7.859 vs 52.741±111.946 μmol/L, P=0.049), direct bilirubin (4.631±4.057 vs. 27.528±58.753 μmol/L, P =0.041), leukocytes (8.027±4.218 vs. 11.925±6.416 ×109/L, P=0.008), neutrophils (6.530±3.994 vs. 10.015±6.029 ×109/L, P=0.011), hemoglobin (94.13±20.460 vs 108.90±25.753 g/L, P=0.018), and hematocrit (0.2838±0.0555 vs. 0.3247±0.0790, P=0.025); (b) Echocardiographic indicators including left ventricular end-diastolic diameter (47.22±14.103 vs. 62.29±11.470mm, P=0.019), left ventricular end-systolic diameter (31.89±10.386 vs. 46.00±13.051mm, P=0.009), and ejection fraction (60.333±8.231 vs. 50.886±14.580%, P=0.05); (c) Physical examinations at the beginning of continuous hemofiltration including systolic blood pressure (131.47±26.271 vs. 114.28±20.800 mmHg, P=0.007), and mean arterial pressure (90.200±18.020 vs. 80.552±17.357 mmHg, P=0.041); (d) average amount of dehydration in continuous hemofiltration process (2184.167±889.364 vs. 1664.166±775.994ml, P=0.020). After adjustment for other factors, leukocytosis was a risk factor for death (OR=1.242, 95% CI: 1.242, 1.480), and higher serum creatinine was not a risk factor for death (OR=0.994, 95% CI: 0.989, 1.000). Conclusions Cardiac function at the beginning of hemofiltration and the amount of dehydration during hemofiltration process were closely related to the prognosis of cardiorenal syndrome patients. Infection and fluid overload condition at the beginning of continuous hemofiltration were independently associated with the mortality of the disease during hospitalization. These results will help us to select suitable patients who can benefit more from continuous hemofiltration.

Key words: Continuous hemofiltration, Cardiorenal syndrome, Mortality during hospitalization, Serum creatinine