Routine laboratory results and thirty day and one-year mortality risk following hospitalization with acute decompensated heart failure.
BACKGROUND
Several blood tests are performed uniformly in patients hospitalized with acute decompensated heart failure and are predictive of the outcomes: complete blood count, electrolytes, renal function, glucose, albumin and uric acid. We sought to evaluate the relationship between routine admission laboratory tests results, patient characteristics and 30-day and one-year mortality of patients admitted for decompensated heart failure and to construct a simple mortality prediction tool.


METHODS
A retrospective population based study. Data from seven tertiary hospitals on all admissions with a principal diagnosis of heart failure during the years 2002-2005 throughout Israel were captured.


RESULTS
8,246 patients were included in the study cohort. Thirty day mortality rate was 8.5% (701 patients) and one-year mortality rate was 28.7% (2,365 patients). Addition of five routine laboratory tests results (albumin, sodium, blood urea, uric acid and WBC) to a set of clinical and demographic characteristics improved c-statistics from 0.76 to 0.81 for 30-days and from 0.72 to 0.76 for one-year mortality prediction (both p-values <0.0001). Three dichotomized abnormal laboratory results with highest odds ratio for one-year mortality (hypoalbuminaemia, hyponatremia and elevated blood urea) were used to construct a simple prediction score, capable of discriminating from 1.1% to 21.4% in 30-day and from 11.6% to 55.6% in one-year mortality rates between patients with a score of 0 (1,477 patients) vs. score of 3 (544 patients).


CONCLUSIONS
A small set of abnormal routine laboratory results upon admission can risk-stratify and independently predict 30-day and one-year mortality in patients hospitalized with acute decompensated heart failure.
Novack
Victor
V
Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel. VictorNo@clalit.org.il
Pencina
Michael
M
Zahger
Doron
D
Fuchs
Lior
L
Nevzorov
Roman
R
Jotkowitz
Allan
A
Porath
Avi
A
D000368:Aged; D002138:Calibration; D019411:Clinical Laboratory Techniques; D003955:Diagnostic Tests, Routine; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors
N Engl J Med. 2004 Aug 5;351(6):543-51
15295047
N Engl J Med. 2000 May 25;342(21):1581-9
10824078
Am Heart J. 2008 May;155(5):883-9
18440336
Circulation. 2009 Apr 14;119(14):1977-2016
19324967
Eur J Heart Fail. 2007 Aug;9(8):776-86
17573240
J Card Fail. 2007 Feb;13(1):42-9
17339002
Circulation. 2003 Apr 22;107(15):1991-7
12707250
Q J Med. 1989 May;71(265):461-6
2602543
JAMA. 2005 Feb 2;293(5):572-80
15687312
Circulation. 2005 May 17;111(19):2454-60
15867182
JAMA. 2003 Nov 19;290(19):2581-7
14625335
Am J Cardiol. 2007 Mar 26;99(6B):15D-20D
17378990
Eur J Heart Fail. 2007 May;9(5):518-24
17064961
J Card Fail. 2006 Jun;12(5):353-9
16762798
Arch Intern Med. 2006 May 22;166(10):1134-42
16717177
Circulation. 1997 Jun 17;95(12):2660-7
9193435
Arch Intern Med. 2006 May 22;166(10):1073-80
16717169
Isr Med Assoc J. 2006 Dec;8(12):875-9
17214110
Am J Cardiol. 1999 Aug 1;84(3):252-7
10496431
J Chronic Dis. 1987;40(5):373-83
3558716
Circulation. 2007 Feb 6;115(5):e69-171
17194875
Circulation. 2006 Mar 21;113(11):1424-33
16534009
Biometrics. 1988 Sep;44(3):837-45
3203132
Int J Cardiol. 2002 Sep;85(1):51-66
12163209
J Am Coll Cardiol. 2006 May 16;47(10):1987-96
16697315
Am J Cardiol. 2005 May 2;95(9A):2B-7B
15847851
N Engl J Med. 2006 Dec 21;355(25):2631-9
17182988
Arch Intern Med. 2004 May 10;164(9):982-8
15136307