Prognostic value of anemia in elderly patients with heart failure with preserved ejection fraction and chronic kidney disease
10.3969/j.issn.1008-0074.2024.05.12
- VernacularTitle:贫血对老年射血分数保留型心力衰竭合并慢性肾脏病患者的预后价值
- Author:
Zhong-Wu ZHANG
1
;
Zhang LIN
;
Shi-Hong WANG
Author Information
1. 福建省老年医院心血管内科,福建 福州 350003
- Keywords:
Heart failure;
Anemia;
Renal insufficiency;
Aged
- From:
Chinese Journal of cardiovascular Rehabilitation Medicine
2024;33(5):568-574
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aims to investigate the predictive value of anemia for adverse cardiovascular events in elderly patients with heart failure with preserved ejection fraction(HFpEF)and chronic kidney disease(CKD).Methods:This prospective study enrolled 215 elderly patients with HFpEF and CKD treated in Fujian Provincial Geriatric Hospital between June 2020 and June 2023.According to hemoglobin(Hb)level at admission,patients were divided into anemia group(n=129,Hb＜130 g/L in males and Hb＜120 g/L in females)and no anemia group(n=86).Complete demographic data,vital signs,New York Heart Association(NYHA)class,and clinical indica-tors including echocardiographic data,cystatin C(CysC),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and creatinine(Cr)etc.were collected in two groups.All patients were followed up monthly for 12 months after discharge.The primary endpoints included heart failure(HF)-caused readmission and cardiac death.Clinical indicators were compared between two groups;Kaplan-Meier survival analysis was used to compare accu-mulative incidence rate of endpoint events between two groups;multivariate Logistic regression was used to analyze influencing factors of endpoint events in elderly patients with HFpEF and CKD during 12-month follow-up,and ROC curve was applied to analyze predictive value of single and combined detection of different indicators for end-point events in these patients.Results:Incidence rate of anemia was 60％(129/215)in elderly patients with HF-pEF and CKD.Compared with those in no anemia group,patients in anemia group had significant lower estimated glomerular filtration rate(eGFR),and significant higher levels of Cr,CysC and NT-proBNP(P＜0.01 all).Pear-son correlation analysis indicated that Hb level was significant positively correlated with eGFR(r=0.428,P＜0.001),and significant inversely correlated with NT-proBNP(r=-0.282,P＜0.001).Kaplan-Meier survival analysis indicated that during 12-month follow-up,incidence of HF-caused readmission and cardiac death in ane-mia group was significantly higher than that of no anemia group(Log-rank x2=15.141,P＜0.001).Multivariate Logistic regression identified CysC and NT-proBNP as independent risk factors for HF-caused readmission and cardiac death during 12-month follow-up in elderly patients with HFpEF and CKD(OR=6.871,1.000,P=0.039 both),while Hb(OR=0.954,P＜0.001)as its independent protective factor.ROC curve analysis indicated that area under the curve(AUC)of combined detection of NT-proBNP,CysC and Hb diagnosing HF-caused re-admission and cardiac death during 12-month follow-up in elderly patients with HFpEF and CKD was 0.839(95％CI 0.779～0.898),which was significantly higher than NT-proBNP alone(AUC=0.719,Z=2.439,P=0.015),but without significant difference with Hb and CysC single detection(P＞0.05 both).Conclusion:Anemia is an independent predictor of endpoint events in elderly patients with HFpEF and CKD and is significantly associat-ed with an increased risk of HF-caused readmission and cardiac death within 12 months.
