心脏淀粉样变性患者的临床特征和预后因素研究

doi:10.3969/j.issn.1002-1949.2019.05.010

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (5): 446-451 DOI: 10.3969/j.issn.1002-1949.2019.05.010

Research of clinical characteristics and prognostic factors in patients with ICU cardiac amyloidosis

Wu Mao-yuan, Xu Chuan-fen, Xu Yan

Department of Cardiology, Rizhao Municipal People′s Hospital, Rizhao 276800, China

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Abstract Objective To retrospectively analyze the clinical characteristic and prognosis of patients with acute heart failure (AHF) entering the ICU for light-chain cardiac amyloidosis (AL-CA). To evaluate the independent and related factors of death and progression to cardiogenic shock in patients with AL-CA. Methods The clinical data of patients with AL-CA who underwent AHF into the intensive care unit (ICU) of Cardiology of Rizhao Municipal People′s Hospital from October 2012 to September 2018 were included. The demographic characteristics, medical history, clinical characteristics, biochemical indicators, echocardiographic parameter, treatment status and clinical prognosis of the patients were collected. The clinical characteristics of AL-CA patients and the treatment of AL-CA patients with cardiogenic shock were analyzed. The patients were divided into survival group and death group according to the death of patients within 3 months after discharge from hospital. Univariate and multivariate logistic regression analysis were used to evaluate the independent factors related to the death of patients within 3 months after discharge. The patients with cardiogenic shock who were in clinical stable state were enrolled in the cardiogenic shock group, and patients with CA who were treated at the same time and had no cardiac events within 1 year were selected as the control group by propensity score matching. Univariate and multivariate logistic regression analysis were used to evaluate independent factors associated with cardiogenic shock in patients. Of the 23 patients who received dobutamine, 17 died. Results The time interval from dobutamine to patient death was (5.3±2.8) d. Twenty-eight (52.8%) patients were younger than 65 years old. Most patients with cardiogenic shock (86.2%, 25/29) died. Multivariate analysis showed that cardiogenic shock (OR=10.329, 95%CI1.761-60.712, P<0.001) and blood urea nitrogen (BUN, OR=1.256, 95%CI1.088-1.561, P=0.003) were independently associated with death within 3 months of the patient. The best diagnostic cut-off value for BUN is 7.5 mmol/L. N-terminal prohormone of B-typenatriuretic peptide (NT-proBNP)(OR=8.707, 95%CI1.856-34.693,P=0.020) was independently associated with cardiogenic shock in AL-CA patients. The best diagnostic cut-off value for serum NT-proBNP is 4050 pg/mL. Conclusion AL-CA patients admitted to ICU for AHF have higher incidence and mortality of cardiogenic shock, and young patients have higher mortality. NT-proBNP has a higher predictive value for evaluating prognosis. The efficacy of phentermamine is poor, and should be actively looking for better dobutamine replacement for first aid treatment.

Key words： Acute heart failure(AHF) Cardiac amyloidosis(CA) Clinical characteristics Prognosis

About author:: Wu Mao-yuan, E-mail: wujerry369@163.com

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Wu Mao-yuan,Xu Chuan-fen,Xu Yan. Research of clinical characteristics and prognostic factors in patients with ICU cardiac amyloidosis[J]. Chinese Journal of Critical Care Medicine, 2019, 39(5): 446-451.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.05.010 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I5/446

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