The determination of the factors impacting on in-hospital mortality in patients with acute heart failure in a tertiary referral centerMehdi Zoghi, Hamza Duygu, Hasan Güngör, Sanem Nalbantgil, Gülsüm Meral Yılmaz, Kamil Tülüce, Filiz Özerkan, Azem Akıllı, Mustafa Akın
Ege Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, İzmir, Türkiye
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.Keywords: Acute heart failure, in-hospital mortality, logistic regression analysis
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.
Conclusion: In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.
Mehdi Zoghi, Hamza Duygu, Hasan Güngör, Sanem Nalbantgil, Gülsüm Meral Yılmaz, Kamil Tülüce, Filiz Özerkan, Azem Akıllı, Mustafa Akın. The determination of the factors impacting on in-hospital mortality in patients with acute heart failure in a tertiary referral center. Anatol J Cardiol. 2008; 8(4): 255-259
Sorumlu Yazar: Hamza Duygu, Türkiye