主要脏不良事件预测心室辅助器件支持患者的生存率降低
Sumita Barua1,2,3, Sean M Conte1,2,4, Callum Cherrett1,2
1Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, Australia.
ESC heart failure
|September 15, 2023
概括
在心室辅助器械 (VAD) 患者中,重大脏不良事件 (MAKE) 显著降低了存活率. 植入后的右心室衰竭和慢性血液溶解是MAKE的关键预测因素,突出了VAD支持中的风险.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗器械 医疗器械
背景情况:
- 对于心室辅助器件 (VAD) 患者的重大脏不良事件 (MAKE) 存在有限的数据.
- 了解MAKE对于改善VAD接受者的结果至关重要.
研究的目的:
- 描述MAKE和VAD患者的存活率之间的关联.
- 为了确定MAKE.的风险因素.
- 在VAD支持的患者中分析脏轨迹.
主要方法:
- 173个连续的VAD植入物 (2010-2019) 的回顾性分析.
- MAKE被定义为持续的eGFR下降,V阶段的CKD,脏替代疗法的开始/延续,或在RRT上死亡.
- 多变量分析以确定风险因素和生存影响.
主要成果:
- 37名患者经历了MAKE.
- 植入后的右心室衰竭 (aOR 9.88) 和慢性血液溶解 (aOR 3.33) 显著增加了MAKE风险.
- MAKE与生存时间的减少有关 (HR 4.80).
- MAKE患者没有显示预期的早期eGFR改善.
结论:
- 在VAD患者中,MAKE显著影响生存率.
- 植入后的右心室衰竭和慢性血液溶解预测MAKE.
- 缺乏早期的eGFR改善可能表明MAKE风险更高.
相关概念视频
Acute Kidney Injury IV: Diagnostic Studies and Prevention
34
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
34
Heart Failure Drugs: Diuretics
418
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
418
Acute Kidney Injury III: Clinical Manifestations
29
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
29
Acute Kidney Injury VI: Nursing Management
32
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
32
Acute Kidney Injury V: Interprofessional Care
25
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
25
Acute Kidney Injury I: Introduction
28
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
28


