Prospective evaluation of pulmonary edema.
OBJECTIVE
To describe the clinical profile and hospital outcome of successive unselected patients with pulmonary edema hospitalized in an internal medicine department.


METHODS
Prospective, consecutive, unsolicited patients diagnosed with pulmonary edema.


METHODS
An internal medicine department in a 900 tertiary care center.


METHODS
A total of 150 consecutive unselected patients (90 males, 60 females; median age, 75 yrs).


RESULTS
Ischemic heart disease, hypertension, various valvular lesions and diabetes mellitus were present in 85%, 70%, 53%, and 52% of patients, respectively. Acute myocardial infarction at admission was observed in 15% of patients. The most common precipitating factors associated with the development of pulmonary edema included: high blood pressure (29%), rapid atrial fibrillation (29%,) unstable angina pectoris (25%), infection (18%), and acute myocardial infarction (15%). Twenty-two patients (15%) were mechanically ventilated. Eighteen patients (12%) died while in the hospital, and the cause of death was cardiac pump failure in 82%. The median hospital stay was 10 days. Predictors for increase rate of in-hospital mortality included: diabetes (p<.05), orthopnea (p<.05), echocardiographic finding of moderate-to-severely depressed global left ventricular systolic function (p<.001), acute myocardial infarction during hospital stay (p<.001), hypotension/shock (p<.05), and the need for mechanical ventilation (p<.001).


CONCLUSIONS
Most patients with pulmonary edema in the internal medicine department are elderly, having ischemic heart disease, hypertension, diabetes, and a previous history of pulmonary edema. The overall mortality is high (in-hospital, 12%) and the predictors associated with high in-hospital mortality are related to left ventricular myocardial function. The long median hospital stay (10 days) and the need for many cardiovascular drugs, impose a considerable cost in the management and health care of these patients.
Edoute
Y
Y
Department of Internal Medicine C, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Roguin
A
A
Behar
D
D
Reisner
S A
SA
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002423:Cause of Death; D048909:Diabetes Complications; D005260:Female; D006331:Heart Diseases / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000150:complications; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial; D016896:Treatment Outcome