[Risk factors and impacts on prognosis of ultrasound lung comets in patients undergoing hemodialysis].

Objective: To investigate the risk factors of ultrasound lung comets and its impact on the survivals of patients undergoing hemodialysis. Methods: One hundred and forty-two patients on hemodialysis (Male 76, female 66) were divided into three groups according to the score of lung comets (mild: ≤14 comets; moderate: 15 to 30 comets; severe: >30 comets). Seventy-two healthy subjects examined by lung ultrasound serve as a control. Pulmonary artery systolic pressure and left ventricular ejection fraction (LVEF) were assessed by Doppler ultrasonography. High-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-α were measured by the automatic analyzer and enzyme-linked immunosorbent assay. Results: With the increasing age of the patients, lung comets scores increased ( P <0.05). There were significant differences in TNF-α ( P <0.05), interdialytic weight gain (IDWG) ( P <0.05), pulmonary artery systolic pressure and LVEF ( P <0.05) among three groups. In multivariate linear regression, the lung comets score was positively related to multiple clinical variables including New York Heart Association (NYHA) classification ( P =0.023), hsCRP ( P =0.042), TNF-α ( P <0.001), IDWG ( P =0.031), and pulmonary artery systolic pressure ( P <0.001). In the multivariate Cox proportional hazards models, lung comets score was independent risk factor for death ( P =0.001). In Kaplan-Meier survival analysis, the risk of all-cause mortality increased in parallel with lung comets score, and patients with lung comets score (>30 comets) were at highest risk of death among all three groups (log-rank test χ(2)=12.73, P =0.001). Conclusion: Lung comets is associated with inflammation, pulmonary artery systolic pressure/volume overload and heart function. Lung comets score represents the alterations of heart function and it may serve as a powerful predictor of all-cause mortality for hemodialysis patients.