Mối liên quan giữa tỷ số De Ritis và kết cục dài hạn ở bệnh nhân suy tim mất bù cấp trên 65 tuổi
Nội dung chính của bài viết
Tóm tắt
Nghiên cứu đoàn hệ tiến cứu kết hợp hồi cứu trên 249 bệnh nhân suy tim mất bù cấp ≥ 65 tuổi (trung vị tuổi 78, 46,2% nam) đánh giá mối liên quan giữa tỷ số De Ritis và tử vong trong 1 năm. Phân tích hồi quy Cox đa biến được thực hiện để xác định mối liên quan. Tỉ lệ tử vong trong 1 năm là 27,3%. Nhóm tử vong có tỷ số De Ritis trung vị cao hơn nhóm còn sống (1,49 so với 1,29; p < 0,001). Phân tích ROC cho thấy tỷ số De Ritis dự báo tử vong với AUC = 0,66, độ nhạy 83,9%, độ đặc hiệu 52%, điểm cắt 1,31. Phân tích Cox đa biến cho thấy các yếu tố liên quan độc lập gồm: tuổi (HR = 1,04; 95% KTC: 1,01 – 1,07; p = 0,022), đái tháo đường típ 2 (HR = 4,73; 95% KTC: 2,38 – 9,40; p < 0,001), tiền căn đột quỵ não (HR = 2,96; 95% KTC: 1,69 – 5,17; p < 0,001), logNT-proBNP (HR = 10,80; 95% KTC: 3,82 – 30,48; p < 0,001), phân suất tống máu (PSTM) thất trái ≤40% (HR = 2,52; 95% KTC: 1,32 – 4,84; p = 0,005) và tỷ số De Ritis ≥1,31 (HR = 2,51; 95% KTC: 1,22 – 5,18; p = 0,013). Tỉ số De Ritis tăng là yếu tố liên quan độc lập với tử vong trong 1 năm ở bệnh nhân STMBC ≥ 65 tuổi, bên cạnh tuổi cao, đái tháo đường, tiền căn đột quỵ não, NT-proBNP và PSTM thất trái giảm.
Chi tiết bài viết
Từ khóa
Người cao tuổi, suy tim mất bù cấp, tỷ số De Ritis, tiên lượng, tử vong
Tài liệu tham khảo
1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368
2. Díez-Villanueva P, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol. 2016;13(2):115-117. doi:10.11909/j.issn.1671-5411.2016.02.009
3. Shrivastava A, Haase T, Zeller T, et al. Biomarkers for Heart Failure Prognosis: Proteins, Genetic Scores and Non-coding RNAs. Front Cardiovasc Med. 2020;7:601364. doi:10.3389/fcvm.2020.601364
4. Djakpo DK, Wang ZQ, Shrestha M. The significance of transaminase ratio (AST/ALT) in acute myocardial infarction. Arch Med Sci – Atheroscler Dis. 2020;5(1):279-283. doi:10.5114/amsad.2020.103028
5. Xanthopoulos A, Starling RC, Kitai T, et al. Heart Failure and Liver Disease: Cardiohepatic Interactions. JACC Hear Fail. 2019;7(2):87-97. doi:10.1016/j.jchf.2018.10.007
6. Maeda D, Kagiyama N, Jujo K, et al. Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure. Sci Rep. 2021;11(1):11957. doi:10.1038/s41598-021-91368-z
7. Schupp T, Rusnak J, Weidner K, et al. Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock. J Clin Med. 2023;12(16):5275. doi:10.3390/jcm12165275
8. Naschitz JE, Slobodin G, Lewis RJ, et al. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. 2000;140(1):111-120. doi:10.1067/mhj.2000.107177
9. Ewid M, Sherif H, Allihimy AS, et al. AST/ALT ratio predicts the functional severity of chronic heart failure with reduced left ventricular ejection fraction. BMC Res Notes. 2020;13:178. doi:10.1186/s13104-020-05031-3
10. Đặng Vạn Phước, Nguyễn Lân Việt, Huỳnh Văn Minh, và cs. 2022 Khuyến cáo của Hội Tim mạch Việt Nam về Chẩn đoán và Điều trị Suy tim cấp và Suy tim mạn.; 2022.
11. AlFaleh H, Elasfar AA, Ullah A, et al. Acute heart failure with and without acute coronary syndrome: Clinical correlates and prognostic impact (From the HEARTS registry). BMC Cardiovasc Disord. 2016;16:98. doi:10.1186/s12872-016-0267-6
12. Jasiewicz M, Siedlaczek M, Kasprzak M, et al. Elevated serum transaminases in patients with acute coronary syndromes: Do we need a revision of exclusion criteria for clinical trials? Cardiol J. 2023;30(5):747-752. doi:10.5603/CJ.a2021.0081
13. World Health Organization. Guideline on Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations. (World Health Organization, ed.). Geneva; 2024. https://www.who.int/publications/i/item/9789240088542.
14. Fonarow GC. Overview of acutely decompensated congestive heart failure (ADHF): A report from the ADHERE Registry. Heart Fail Rev. 2005;9(3):179-185. doi:10.1007/s10741-005-6127-6
15. Verdu-Rotellar JM, Vaillant-Roussel H, Abellana R, et al. Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care. Scand J Prim Health Care. 2020;38(4):473-480. doi:10.1080/02813432.2020.1844387
16. Bendary A, Hassanein M, Bendary M, et al. The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry. Egypt Hear J. 2023;75(1):16. doi:10.1186/s43044-023-00342-9
17. Cardoso JN, Del Carlo CH, de Oliveira Junior MT, et al. Infection in patients with decompensated heart failure: In-hospital mortality and outcome. Arq Bras Cardiol. 2018;110(4):364-370. doi:10.5935/abc.20180037
18. Cao Y, Guo S, Dong Y, et al. Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction. ESC Hear Fail. 2023;10(3):1771-1780. doi:10.1002/ehf2.14336
19. Nikolaou M, Parissis J, Yilmaz MB, et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J. 2013;34(10):742-749. doi:10.1093/eurheartj/ehs332
20. Maeda D, Sakane K, Kanzaki Y, et al. Relation of aspartate aminotransferase to alanine aminotransferase ratio to nutritional status and prognosis in patients with acute heart failure. Am J Cardiol. 2021;139:64-70. doi:10.1016/j.amjcard.2020.10.036
21. Zoppini G, Cacciatori V, Negri C, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Med (United States). 2016;95(43). doi:10.1097/MD.0000000000004821
22. Sette LHBC, Lopes EP de A. The reduction of serum aminotransferase levels is proportional to the decline of the glomerular filtration rate in patients with chronic kidney disease. Clinics. 2015;70(5):346-349. doi:10.6061/clinics/2015(05)07
23. Huang JW, Yen CJ, Pai MF, et al. Association between serum aspartate transaminase and homocysteine levels in hemodialysis patients. Am J Kidney Dis. 2002;40(6):1195-1201. doi:10.1053/ajkd.2002.36948b
24. Ndrepepa G. De Ritis ratio and cardiovascular disease: evidence and underlying mechanisms. J Lab Precis Med. 2023;8:6. doi:10.21037/JLPM-22-68
25. Ferrannini G, Rosenthal N, Hansen MK, et al. Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program. Cardiovasc Diabetol. 2022;21(1):127. doi:10.1186/s12933-022-01558-w
26. Liu X, Liu P. Elevated AST/ALT ratio is associated with all-cause mortality in patients with stable coronary artery disease: a secondary analysis based on a retrospective cohort study. Sci Rep. 2022;12(1):9231. doi:10.1038/s41598-022-13355-2
27. Liu HH, Cao YX, Jin JL, et al. Liver fibrosis scoring systems as novel tools for predicting cardiovascular outcomes in patients following elective percutaneous coronary intervention. J Am Heart Assoc. 2021;10(3):e018869. doi:10.1161/JAHA.120.018869
28. Ndrepepa G, Holdenrieder S, Kastrati A. De Ritis ratio and long-term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention. Eur J Clin Invest. 2023;53(5):e13942.
29. Chioncel O, Lainscak M, Seferovic PM, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(12):1574–1585.
30. Marques I, Mendonça D, Teixeira L. One-year rehospitalisation and mortality after acute heart failure hospitalisation: a competing risk analysis. Open Hear. 2023;10(1):e002167. doi:10.1136/openhrt-2022-002167
31. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
32. Scrutinio D, Ammirati E, Guida P, et al. The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure. J Hear Lung Transplant. 2014;33(4):404-411. doi:10.1016/j.healun.2013.12.005
33. Doehner W, Böhm M, Boriani G, et al. Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis. Eur J Heart Fail. 2023;25(12):2107-2129. doi:10.1002/ejhf.3071
34. Lorlowhakarn K, Arayakarnkul S, Trongtorsak A, et al. Outcomes and predictors of one-year mortality in patients hospitalized with Acute Heart Failure. IJC Hear Vasc. 2022;43:101159. doi:10.1016/j.ijcha.2022.101159
2. Díez-Villanueva P, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol. 2016;13(2):115-117. doi:10.11909/j.issn.1671-5411.2016.02.009
3. Shrivastava A, Haase T, Zeller T, et al. Biomarkers for Heart Failure Prognosis: Proteins, Genetic Scores and Non-coding RNAs. Front Cardiovasc Med. 2020;7:601364. doi:10.3389/fcvm.2020.601364
4. Djakpo DK, Wang ZQ, Shrestha M. The significance of transaminase ratio (AST/ALT) in acute myocardial infarction. Arch Med Sci – Atheroscler Dis. 2020;5(1):279-283. doi:10.5114/amsad.2020.103028
5. Xanthopoulos A, Starling RC, Kitai T, et al. Heart Failure and Liver Disease: Cardiohepatic Interactions. JACC Hear Fail. 2019;7(2):87-97. doi:10.1016/j.jchf.2018.10.007
6. Maeda D, Kagiyama N, Jujo K, et al. Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure. Sci Rep. 2021;11(1):11957. doi:10.1038/s41598-021-91368-z
7. Schupp T, Rusnak J, Weidner K, et al. Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock. J Clin Med. 2023;12(16):5275. doi:10.3390/jcm12165275
8. Naschitz JE, Slobodin G, Lewis RJ, et al. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. 2000;140(1):111-120. doi:10.1067/mhj.2000.107177
9. Ewid M, Sherif H, Allihimy AS, et al. AST/ALT ratio predicts the functional severity of chronic heart failure with reduced left ventricular ejection fraction. BMC Res Notes. 2020;13:178. doi:10.1186/s13104-020-05031-3
10. Đặng Vạn Phước, Nguyễn Lân Việt, Huỳnh Văn Minh, và cs. 2022 Khuyến cáo của Hội Tim mạch Việt Nam về Chẩn đoán và Điều trị Suy tim cấp và Suy tim mạn.; 2022.
11. AlFaleh H, Elasfar AA, Ullah A, et al. Acute heart failure with and without acute coronary syndrome: Clinical correlates and prognostic impact (From the HEARTS registry). BMC Cardiovasc Disord. 2016;16:98. doi:10.1186/s12872-016-0267-6
12. Jasiewicz M, Siedlaczek M, Kasprzak M, et al. Elevated serum transaminases in patients with acute coronary syndromes: Do we need a revision of exclusion criteria for clinical trials? Cardiol J. 2023;30(5):747-752. doi:10.5603/CJ.a2021.0081
13. World Health Organization. Guideline on Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations. (World Health Organization, ed.). Geneva; 2024. https://www.who.int/publications/i/item/9789240088542.
14. Fonarow GC. Overview of acutely decompensated congestive heart failure (ADHF): A report from the ADHERE Registry. Heart Fail Rev. 2005;9(3):179-185. doi:10.1007/s10741-005-6127-6
15. Verdu-Rotellar JM, Vaillant-Roussel H, Abellana R, et al. Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care. Scand J Prim Health Care. 2020;38(4):473-480. doi:10.1080/02813432.2020.1844387
16. Bendary A, Hassanein M, Bendary M, et al. The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry. Egypt Hear J. 2023;75(1):16. doi:10.1186/s43044-023-00342-9
17. Cardoso JN, Del Carlo CH, de Oliveira Junior MT, et al. Infection in patients with decompensated heart failure: In-hospital mortality and outcome. Arq Bras Cardiol. 2018;110(4):364-370. doi:10.5935/abc.20180037
18. Cao Y, Guo S, Dong Y, et al. Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction. ESC Hear Fail. 2023;10(3):1771-1780. doi:10.1002/ehf2.14336
19. Nikolaou M, Parissis J, Yilmaz MB, et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J. 2013;34(10):742-749. doi:10.1093/eurheartj/ehs332
20. Maeda D, Sakane K, Kanzaki Y, et al. Relation of aspartate aminotransferase to alanine aminotransferase ratio to nutritional status and prognosis in patients with acute heart failure. Am J Cardiol. 2021;139:64-70. doi:10.1016/j.amjcard.2020.10.036
21. Zoppini G, Cacciatori V, Negri C, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Med (United States). 2016;95(43). doi:10.1097/MD.0000000000004821
22. Sette LHBC, Lopes EP de A. The reduction of serum aminotransferase levels is proportional to the decline of the glomerular filtration rate in patients with chronic kidney disease. Clinics. 2015;70(5):346-349. doi:10.6061/clinics/2015(05)07
23. Huang JW, Yen CJ, Pai MF, et al. Association between serum aspartate transaminase and homocysteine levels in hemodialysis patients. Am J Kidney Dis. 2002;40(6):1195-1201. doi:10.1053/ajkd.2002.36948b
24. Ndrepepa G. De Ritis ratio and cardiovascular disease: evidence and underlying mechanisms. J Lab Precis Med. 2023;8:6. doi:10.21037/JLPM-22-68
25. Ferrannini G, Rosenthal N, Hansen MK, et al. Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program. Cardiovasc Diabetol. 2022;21(1):127. doi:10.1186/s12933-022-01558-w
26. Liu X, Liu P. Elevated AST/ALT ratio is associated with all-cause mortality in patients with stable coronary artery disease: a secondary analysis based on a retrospective cohort study. Sci Rep. 2022;12(1):9231. doi:10.1038/s41598-022-13355-2
27. Liu HH, Cao YX, Jin JL, et al. Liver fibrosis scoring systems as novel tools for predicting cardiovascular outcomes in patients following elective percutaneous coronary intervention. J Am Heart Assoc. 2021;10(3):e018869. doi:10.1161/JAHA.120.018869
28. Ndrepepa G, Holdenrieder S, Kastrati A. De Ritis ratio and long-term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention. Eur J Clin Invest. 2023;53(5):e13942.
29. Chioncel O, Lainscak M, Seferovic PM, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(12):1574–1585.
30. Marques I, Mendonça D, Teixeira L. One-year rehospitalisation and mortality after acute heart failure hospitalisation: a competing risk analysis. Open Hear. 2023;10(1):e002167. doi:10.1136/openhrt-2022-002167
31. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
32. Scrutinio D, Ammirati E, Guida P, et al. The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure. J Hear Lung Transplant. 2014;33(4):404-411. doi:10.1016/j.healun.2013.12.005
33. Doehner W, Böhm M, Boriani G, et al. Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis. Eur J Heart Fail. 2023;25(12):2107-2129. doi:10.1002/ejhf.3071
34. Lorlowhakarn K, Arayakarnkul S, Trongtorsak A, et al. Outcomes and predictors of one-year mortality in patients hospitalized with Acute Heart Failure. IJC Hear Vasc. 2022;43:101159. doi:10.1016/j.ijcha.2022.101159