Prognostic factors in acute cardiogenic pulmonary edema.
The purpose of this study was to determine the clinical and biological findings at admission in the Department of Emergency Medicine associated with a poor prognosis, and to evaluate early response to treatment as a prognostic factor. It was a prospective cohort study with a 5-month follow-up. One hundred eighty-six patients admitted for acute cardiogenic pulmonary edema were included. Features were analyzed at the admission and on response to initial treatment. The main outcome measure was survival at 2 end-points: hospital discharge, and 5 months of follow-up. Multivariate analysis showed that in-hospital mortality was associated with marbleization (mottling) odd-ratio (OR) = 9.0), low diuresis (OR = 4.0), high breath rate 6 hours after admission (OR = 4.0), and chronic digoxin use (OR = 3.39). Five-month mortality was associated with a bedridden state (OR = 9.0), marbleization (mottling) (OR = 5.5), myocardial infarction (OR = 3), and poor early response to initial treatment (OR = 3.2). In addition to well-known factors, the response to initial treatment evaluated 6 hours after admission was a major determinant of outcome.
Le Conte
P
P
Department of Emergency Medicine, Centre Hospitalier et Universitaire, Hôtel Dieu, Nantes, France.
Coutant
V
V
N'Guyen
J M
JM
Baron
D
D
Touze
M D
MD
Potel
G
G
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D007866:Leg / Q000098:blood supply; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D012039:Regional Blood Flow / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome