关键词: 心力衰竭, 肾功能不全, 影响因素分析, 预后, 预测

Abstract: Objective　To determine the associated factors for worsening renal function（WRF） in very old patients with severe acute decompensated heart failure（ADHF） and to examine the value of WRF for predicting the short-term outcome of these patients.Methods　We enrolled 108 consecutive very old（age ≥ 80，averaged 87.1） inpatients with severe ADHF from Chinese PLA General Hospital between January 2008 and January 2010.We collected their demographic characteristics and clinical data including anti-heart failure drug treatment.WRF was defined as an increase in serum creatinine levels from the first day to the seventh day after admission >0.3 mg/dl or >25%.All-cause mortality was recorded over the follow-up period of 6 months.Influencing factors of WRF and value of WRF in predicting all-cause mortality were then evaluated in all patients.Results　44 were identified with WRF.Multivariate Logistic regression analysis revealed that baseline eGFR，NT-proBNP and coexistence of CKD were independent predictors for WRF（P<0.05）．All-cause mortality rates were 70.5%（31/44）in WRF group and 46.9%（30/64）in non-WRF group．Cox regression analysis found that baseline SBP，hemoglobin，BUN and serum potassium as well as WRF were independent predictors for all-cause mortality（P<0.05）.Conclusion　Coexistence of CKD was an independent influencing factor of WRF，and WRF increased the risk of all-cause mortality in very old patients with severe ADHF.

Key words: Heart failure, Renal insufficiency, Root cause analysis, Prognosis, Forecasting