title: Predictors of 30-day mortality in patients admitted to ED for acute heart failure.
abstract: OBJECTIVE
  Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality.
  
  
  METHODS
  We conducted a single site, retrospective review of adult patients (≥18years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period.
  
  
  RESULTS
  There were a total of 322 patients. Mean age was 83.9±9.1years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30days of admission to the ED. The following three characteristics were associated with increased mortality: age>85years (OR=1.5[95%CI:0.8-2.7], p=0.01), creatinine clearance <30mL/min (OR=2.6[95%CI:1.4-5], p<0.001) and Nt-proBNP >5000pg/mL (OR=2.2[95%CI:1.2-4], p<0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634-0.935], p<0.001). For 7-day mortality, it was 7900pg/mL (0.698 [0.578-0.819], p<0.001) and for 30-day mortality, 5000pg/mL (0.667 [0.576-0.758], p<0.001).
  
  
  CONCLUSIONS
  Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF.
authors.affiliation: Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France. Electronic address: matthieu.marchetti@gmail.com.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Marchetti
authors.affiliation: Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France; University of Poitiers, Medical School, 86000 Poitiers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.affiliation: Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lardeur
authors.affiliation: Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France; University of Poitiers, Medical School, 86000 Poitiers, France.
authors.forename: Jérémy
authors.initials: J
authors.lastname: Guenezan
authors.affiliation: Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France; University of Poitiers, Medical School, 86000 Poitiers, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Marjanovic
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D019540:Area Under Curve; D015897:Comorbidity; D003401:Creatine / Q000097:blood*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D020097:Natriuretic Peptide, Brain; D003401:Creatine
keywords: Acute heart failure; Emergency; Mortality; Natriuretic brain peptide