Rohde Luis E, Goldraich Lívia, Polanczyk Carisi A, Borges Aníbal Pires, Biolo Andréia, Rabelo Eneida, Beck-Da-Silva Luis, Clausell Nadine
Heart Failure and Cardiac Transplantation Unit, Cardiology Division at Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul Medical School, Porto Alegre, Brazil.
J Card Fail. 2006 Oct;12(8):587-93. doi: 10.1016/j.cardfail.2006.06.475.
Scarce data are available to predict in-hospital mortality for decompensated heart failure (HF) in South American populations.
We evaluated 779 consecutive HF admissions defined by the Boston criteria in a tertiary care hospital. Stepwise logistic regression was used to determine independent correlates of in-hospital mortality, derived from 83 potential predictors collected on hospital admission. A clinical score rule (HF Revised Score) was created using the regression coefficient estimates derived from multivariate modeling. During hospital stay, 77 (10%) deaths occurred and 6 clinical characteristics were independently associated with in-hospital mortality: presence of cancer (P < .001), systolic blood pressure < or =124 mm Hg (P < .001), serum creatinine >1.4 mg/dL (P = .02), blood urea nitrogen >37 mg/dL (P = .03), serum sodium <136 mEq/L (P = .03), and age >70 years old (P = .03). Both the Acute Decompensated Heart Failure National Registry stratification algorithm and the proposed HF Revised Score performed adequately to predict in-hospital mortality ("c" statistics = 0.71 and 0.76, respectively). The newly proposed score, however, discriminated a very low-risk group (101 [13%]) in whom all patients were discharged home, representing patients admitted with none of the 6 predictors of risk.
HF risk stratification can be accurately accomplished during the first day of admission with simple and easily obtained clinical variables.
在南美人群中，用于预测失代偿性心力衰竭（HF）患者院内死亡率的数据稀缺。
我们在一家三级护理医院评估了779例符合波士顿标准的连续性HF住院患者。采用逐步逻辑回归来确定院内死亡率的独立相关因素，这些因素来自入院时收集的83个潜在预测指标。利用多变量建模得出的回归系数估计值创建了一个临床评分规则（HF修订评分）。住院期间，77例（10%）患者死亡，6项临床特征与院内死亡率独立相关：癌症（P <.001）、收缩压≤124 mmHg（P <.001）、血清肌酐>1.4 mg/dL（P =.02）、血尿素氮>37 mg/dL（P =.03）、血清钠<136 mEq/L（P =.03）以及年龄>70岁（P =.03）。急性失代偿性心力衰竭国家注册分层算法和提议的HF修订评分在预测院内死亡率方面均表现良好（“c”统计量分别为0.71和0.76）。然而，新提议的评分鉴别出了一个极低风险组（101例[13%]），该组所有患者均出院回家，这些患者入院时均无6项风险预测指标中的任何一项。
入院第一天即可通过简单且易于获取的临床变量准确完成HF风险分层。
