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

摘要： 目的　分析高龄严重急性失代偿性心力衰竭（ADHF）患者发生肾功能恶化（WRF）的影响因素，以及WRF对严重ADHF患者预后的预测价值。方法　连续入选2008年1月—2010年1月中国人民解放军总医院收治的因严重ADHF住院的高龄（年龄≥80岁）患者108例。收集患者的基线资料及抗心力衰竭药物使用情况。以入院7 d血肌酐较基线资料升高>0.3 mg/dl或>25%为WRF的诊断标准，并将患者分为WRF组和非WRF组。随访6个月，记录严重ADHF患者发病6个月后的全因死亡。分析所有患者发生WRF的影响因素，以及WRF对全因死亡的预测价值。结果　患者平均年龄87.1岁。WRF组44例患者，非WRF组64例患者。多因素Logistic回归分析结果显示，基线资料中的估算肾小球滤过率、N末端脑钠肽前体、是否合并慢性肾脏病（CKD）是严重ADHF患者发生WRF的独立影响因素（P<0.05）。截至随访结束，WRF组全因死亡率为70.5%（31/44）；非WRF组全因死亡率为46.9%（30/64）。Cox回归分析结果显示，基线资料中的收缩压、血红蛋白、血尿素氮、血钾以及是否发生WRF是严重ADHF患者发病6个月后发生全因死亡的独立影响因素（P<0.05）。结论　高龄严重ADHF患者合并CKD是其发生WRF的危险因素，而WRF又增加了严重ADHF患者全因死亡的发生风险。

关键词: 心力衰竭, 肾功能不全, 影响因素分析, 预后, 预测