[The determination of the factors impacting on in-hospital mortality in patients with acute heart failure in a tertiary referral center].
OBJECTIVE
Despite impressive advances in therapeutics in the last years, acute heart failure (AHF) remains a major cause of cardiovascular morbidity and mortality. Patients hospitalized because of heart failure (HF), irrespective of left ventricular systolic function, represent a high-risk population with limited short-term prognosis. A substantial component of HF-related mortality occurs during a hospital stay. In this study, we aimed to determine the factors impacting on in-hospital mortality in patients with AHF.


METHODS
During a 15-month period (December 2005-March 2007), 85 consecutive patients with (mean age: 64+/-8 years, male: 54%) an episode of AHF were included in this study. The effect of demographic, clinical, electrocardiographic, and echocardiographic characteristics, laboratory findings on in-hospital mortality were evaluated retrospectively.


RESULTS
Of 85 patients 24.7% of patients had new-onset HF. Coronary artery disease (61%) was the most common underlying disease. The 44.7% of patients had hypertension, 37.6% had diabetes mellitus, 21% had chronic renal failure and 16.4% had chronic obstructive pulmonary disease. Left ventricular ejection fraction was 35+/-7%. In-hospital mortality rate was found as 11.7% (10 patients). The major cause of mortality was the progression of HF to cardiogenic shock in 60% of deaths. In comparison with surviving patients in terms of the clinical, demographic, electrocardiographic, and laboratory characteristics and left and right ventricular functions, patients died during hospitalization had higher blood urea nitrogen (45+/-20 mg/dl vs. 36+/-12 mg/dl, p=0.04), higher creatinine level (2.2+/-0.8 mg/dl vs. 1.1+/-0.5 mg/dl, p=0.001), and wider QRS duration (130+/-13 ms vs. 116+/-18 ms, p=0.04) whereas they had lower plasma sodium level (128+/-5 mmol/l vs. 135+/-9 mmol/l, p=0.02) and systolic blood pressure (p=0.01). Logistic regression analysis revealed that plasma creatinine level (OR 1.5, 95% CI 1.2 to 2.1, p=0.01), blood urea nitrogen (OR 2.1, 95% CI 1.8 to 3.1, p=0.001), plasma sodium level (OR 1.3, 95% CI 1.1 to 1.7, p=0.02), and systolic blood pressure (OR 2.2, 95% CI 1.9 to 2.8, p=0.01) were the independent predictors of in-hospital mortality.


CONCLUSIONS
In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.
Zoghi
Mehdi
M
Ege Universitesi Tip Fakültesi Kardiyoloji Anabilim Dali, Izmir, Türkiye.
Duygu
Hamza
H
Güngör
Hasan
H
Nalbantgil
Sanem
S
Yilmaz
Gülsüm Meral
GM
Tülüce
Kamil
K
Ozerkan
Filiz
F
Akilli
Azem
A
Akin
Mustafa
M
D001794:Blood Pressure / Q000502:physiology*; D001806:Blood Urea Nitrogen; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality*; D012964:Sodium / Q000097:blood; D013599:Systole / Q000502:physiology
D012964:Sodium; D003404:Creatinine