The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure

YILMAZ, MEHMET BIRHAN; BEKTAŞOĞLU, Gökhan; TANDOĞAN, İzzet; Zorlu, Ali; YONTAR, Osman Can

The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure

Mehmet Birhan YILMAZ, (Cumhuriyet Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Sivas, Türkiye)

Ali ZORLU, (Cumhuriyet Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Sivas, Türkiye)

Gökhan BEKTAŞOĞLU, (Cumhuriyet Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Sivas, Türkiye)

Osman Can YONTAR, (Cumhuriyet Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Sivas, Türkiye)

İzzet TANDOĞAN (Cumhuriyet Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Sivas, Türkiye)

Türk Kardiyoloji Derneği Arşivi

1 0

Yıl: 2012 Cilt: 40 Sayı: 1 Sayfa Aralığı: 9 - 15 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure

Öz:

Amaç: Kardiyorenal anemi sendromu kalp yetersizliği (KY) hastalarında tanımlanmıştır. Renal bozukluğun ve aneminin ayrı ayrı etkileri daha önce ortaya konmuş olsa da, böbrek, kemik iliği ve kalp arasındaki karmaşık etkileşim, hastalığı daha hafif olan kişilerde karar verme işlemini nispeten verimsiz kılar. Bu çalışmada, tahmini glomerül filtrasyon hızı (eGFR) ve hemoglobin (Hb) çarpımının KY hastalarında sonlanımı öngörmedeki rolünü araştırmayı amaçladık. Çalışma planı: Çalışmaya, akut dekompanse sistolik KY tanısıyla hastaneye yatırılıp taburcu edilen ardışık 148 hasta (89 erkek, 59 kadın; ort. yaş 68±10) alındı. Taburcu edilirken Hb düzeyleri ölçüldü, böbrek fonksiyonu MDRD (Modification of Diet in Renal Disease) formülü ile belirlendi. eGFRxHb çarpımı hesaplanarak, ROC (alıcı işletim karakteristiği) analiziyle kesim değeri çıkarıldı. Hastaların 34 aya varan takipleri (ort. 8.2±5.5 ay) sonrasında eGFRxHb çarpımı değerinin ölüm üzerindeki etkisi araştırıldı. Bulgular: Hasta grubunda ortalama Hb 12.7±2 gr/dl, ortalama kreatinin 105±46 μmol/l ve ortalama eGFR 61±23 ml/dk/1.73 m2 bulundu. Seksen iki hastada (%55.4) eGFR <60 ml/kg/m2 idi. İzlem sırasında 27 hasta öldü. eGFRxHb çarpımının mortaliteyi öngörmede kesim değeri ≤788 bulunurken, duyarlığı %82.6, özgüllüğü %51.3 idi. Çokdeğişkenli Cox orantılı analizinde, sadece eGFRxHb çarpımının ≤788 olması (HR 4.488, %95 GA 1.500-13.433, p=0.007) ve atriyal fibrilasyon varlığı (HR 2.644, %95 GA 1.113-6.280, p=0.028) sistolik KY hastalarında ölümün bağımsız öngördürücüleri olarak bulundu. Sonuç: eGFRxHb çarpımının sistolik KY olan hastalarda ölümün öngörülmesinde yararlı olabileceği sonucuna varıldı.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

eGFR ve hemoglobin çarpımı, ciddi anemi ve böbrek yetersizliği olmaksızın sistolik kalp yetersizliği olan hastalarda mortaliteyi öngörmede yardımcı olabilir

Öz:

Objectives: Cardiorenal anemia syndrome is defined in patients with heart failure (HF). Although individual influ- ences of renal impairment and anemia were shown pre- viously, complex interaction between the kidney, bone marrow, and the heart renders decision making relatively inefficient in patients with milder forms of these diseases. We aimed to investigate whether product of estimated glo- merular filtration rate (eGFR) and hemoglobin (Hb) pre- dicts outcomes in patients with HF.Study design: The study included 148 consecutive pa- tients (89 males, 59 females; mean age 68±10 years) who were hospitalized with acutely decompensated systolic HF and discharged alive. Discharge Hb levels were measured. Renal function was estimated via the MDRD (Modification of Diet in Renal Disease) formula. The eGFR x Hb product was derived, and cut-off was defined using the ROC (re- ceiver operating characteristic) analysis. The influence of eGFR x Hb product on mortality was analyzed after a fol- low-up period of up to 34 months (mean 8.2±5.5 months).Results: The mean Hb was 12.7±2 g/dl, the mean creati- nine was 105±46 μmol/l, and the mean eGFR was 61±23 ml/min/1.73 m2. Eighty-two patients (55.4%) had an eGFR of <60 ml/kg/m2. During the follow-up, 27 patients died. Optimal cut-off level of eGFR x Hb product to predict mor- tality was found to be ≤788 with a sensitivity of 82.6% and specificity of 51.3%. In multivariate Cox proportional analysis, only eGFR x Hb product ≤788 (HR 4.488, 95% CI 1.500-13.433, p=0.007) and presence of atrial fibrillation (HR 2.644, 95% CI 1.113-6.280, p=0.028) were indepen- dent predictors of mortality in patients with HF.Conclusion: We concluded that the product of eGFR and Hb might be useful in prediction of mortality among pa- tients with systolic HF.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

TRDizin Dışındaki Atıf Sayıları

OpenCitations: 0

OpenAlex: 0

Crossref: 0

1. Ruilope LM, van Veldhuisen DJ, Ritz E, Luscher TF. Renal function: the Cinderella of cardiovascular risk profile. J Am Coll Cardiol 2001;38:1782-7.
2. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2001;38:955-62.
3. Ronco C. Cardiorenal syndromes: definition and classification. Contrib Nephrol 2010;164:33-8.
4. Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D. Anemia, chronic renal disease and congestive heart failure-the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol 2006;38:295-310.
5. Scrutinio D, Passantino A, Santoro D, Catanzaro R. The cardiorenal anaemia syndrome in systolic heart failure: prevalence, clinical correlates, and long-term survival. Eur J Heart Fail 2011;13:61-7.
6. Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, et al. Cardiorenal interactions. Insights from the ESCAPE trial. J Am Coll Cardiol 2008;51:1268-74.
7. Damman K, Jaarsma T, Voors AA, Navis G, Hillege HL, van Veldhuisen DJ, et al. Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH). Eur J Heart Fail 2009;11:847-54.
8. Manjunath G, Sarnak MJ, Levey AS. Prediction equations to estimate glomerular filtration rate: an update. Curr Opin Nephrol Hypertens 2001;10:785-92.
9. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108.
10. Petretta M, Scopacasa F, Fontanella L, Carlomagno A, Baldissara M, de Simone A, et al. Prognostic value of reduced kidney function and anemia in patients with chronic heart failure. J Cardiovasc Med 2007;8:909-16.
11. Gardner RS, Chong KS, OMeara E, Jardine A, Ford I, McDonagh TA. Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure. Eur Heart J 2007;28:3027-33.
12. Kimura H, Hiramitsu S, Miyagishima K, Mori K, Yoda R, Kato S, et al. Cardio-renal interaction: impact of renal function and anemia on the outcome of chronic heart failure. Heart Vessels 2010;25:306-12.
13. Besarab A, Hörl WH, Silverberg D. Iron metabolism, iron deficiency, thrombocytosis, and the cardiorenal anemia syndrome. Oncologist 2009;14 Suppl 1:22-33.
14. Kazory A, Ross EA. Anemia: the point of convergence or divergence for kidney disease and heart failure? J Am Coll Cardiol 2009;53:639-47.
15. Scrutinio D, Passantino A, Lagioia R, Santoro D, Cacciapaglia E. Detection and prognostic impact of renal dysfunction in patients with chronic heart failure and normal serum creatinine. Int J Cardiol 2011;147:228-33.
16. Smilde TD, van Veldhuisen DJ, Navis G, Voors AA, Hillege HL. Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction. Circulation 2006; 114:1572-80.
17. Shlipak MG, Smith GL, Rathore S, Massie BM, Krumholz HM. Renal function, digoxin therapy, and heart failure outcomes: evidence from the Digoxin Intervention Group Trial. J Am Soc Nephrol 2004;15:2195-203.
18. Silverberg DS, Wexler D, Iaina A. The role of anemia in the progression of congestive heart failure. Is there a place for erythropoietin and intravenous iron? J Nephrol 2004;17:749-61.
19. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009;53:589-96.

APA	YILMAZ M, Zorlu A, BEKTAŞOĞLU G, YONTAR O, TANDOĞAN İ (2012). The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. , 9 - 15.
Chicago	YILMAZ MEHMET BIRHAN,Zorlu Ali,BEKTAŞOĞLU Gökhan,YONTAR Osman Can,TANDOĞAN İzzet The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. (2012): 9 - 15.
MLA	YILMAZ MEHMET BIRHAN,Zorlu Ali,BEKTAŞOĞLU Gökhan,YONTAR Osman Can,TANDOĞAN İzzet The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. , 2012, ss.9 - 15.
AMA	YILMAZ M,Zorlu A,BEKTAŞOĞLU G,YONTAR O,TANDOĞAN İ The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. . 2012; 9 - 15.
Vancouver	YILMAZ M,Zorlu A,BEKTAŞOĞLU G,YONTAR O,TANDOĞAN İ The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. . 2012; 9 - 15.
IEEE	YILMAZ M,Zorlu A,BEKTAŞOĞLU G,YONTAR O,TANDOĞAN İ "The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure." , ss.9 - 15, 2012.
ISNAD	YILMAZ, MEHMET BIRHAN vd. "The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure". (2012), 9-15.

APA	YILMAZ M, Zorlu A, BEKTAŞOĞLU G, YONTAR O, TANDOĞAN İ (2012). The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. Türk Kardiyoloji Derneği Arşivi, 40(1), 9 - 15.
Chicago	YILMAZ MEHMET BIRHAN,Zorlu Ali,BEKTAŞOĞLU Gökhan,YONTAR Osman Can,TANDOĞAN İzzet The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. Türk Kardiyoloji Derneği Arşivi 40, no.1 (2012): 9 - 15.
MLA	YILMAZ MEHMET BIRHAN,Zorlu Ali,BEKTAŞOĞLU Gökhan,YONTAR Osman Can,TANDOĞAN İzzet The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. Türk Kardiyoloji Derneği Arşivi, vol.40, no.1, 2012, ss.9 - 15.
AMA	YILMAZ M,Zorlu A,BEKTAŞOĞLU G,YONTAR O,TANDOĞAN İ The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. Türk Kardiyoloji Derneği Arşivi. 2012; 40(1): 9 - 15.
Vancouver	YILMAZ M,Zorlu A,BEKTAŞOĞLU G,YONTAR O,TANDOĞAN İ The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure. Türk Kardiyoloji Derneği Arşivi. 2012; 40(1): 9 - 15.
IEEE	YILMAZ M,Zorlu A,BEKTAŞOĞLU G,YONTAR O,TANDOĞAN İ "The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure." Türk Kardiyoloji Derneği Arşivi, 40, ss.9 - 15, 2012.
ISNAD	YILMAZ, MEHMET BIRHAN vd. "The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure". Türk Kardiyoloji Derneği Arşivi 40/1 (2012), 9-15.