Zoghi Mehdi, Duygu Hamza, Güngör Hasan, Nalbantgil Sanem, Yilmaz Gülsüm Meral, Tülüce Kamil, Ozerkan Filiz, Akilli Azem, Akin Mustafa
Ege Universitesi Tip Fakültesi Kardiyoloji Anabilim Dali, Izmir, Türkiye.
Anadolu Kardiyol Derg. 2008 Aug;8(4):255-9.
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.
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.
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.
In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.
尽管近年来治疗方法取得了显著进展，但急性心力衰竭（AHF）仍然是心血管疾病发病和死亡的主要原因。因心力衰竭（HF）住院的患者，无论左心室收缩功能如何，都是短期预后有限的高危人群。与HF相关的死亡有很大一部分发生在住院期间。在本研究中，我们旨在确定影响AHF患者住院死亡率的因素。
在15个月期间（2005年12月至2007年3月），本研究纳入了85例连续发生AHF的患者（平均年龄：64±8岁，男性：54%）。回顾性评估人口统计学、临床、心电图和超声心动图特征、实验室检查结果对住院死亡率的影响。
85例患者中，24.7%为新发HF。冠状动脉疾病（61%）是最常见的基础疾病。44.7%的患者患有高血压，37.6%患有糖尿病，21%患有慢性肾衰竭，16.4%患有慢性阻塞性肺疾病。左心室射血分数为35±7%。住院死亡率为11.7%（10例患者）。60%的死亡病例中，死亡的主要原因是HF进展为心源性休克。与存活患者相比，在临床、人口统计学、心电图、实验室特征以及左右心室功能方面，住院期间死亡的患者血尿素氮水平更高（45±20mg/dl对36±12mg/dl，p=0.04），肌酐水平更高（2.2±0.8mg/dl对1.1±0.5mg/dl，p=0.001），QRS时限更宽（130±13ms对116±18ms，p=0.04），而血浆钠水平更低（128±5mmol/l对135±9mmol/l，p=0.02）和收缩压更低（p=0.01）。逻辑回归分析显示，血浆肌酐水平（OR 1.5，95%CI 1.2至2.1，p=0.01）、血尿素氮（OR 2.1，95%CI 1.8至3.1，p=0.001）、血浆钠水平（OR 1.3，95%CI 1.1至1.7，p=0.02）和收缩压（OR 2.2，95%CI 1.9至2.8，p=0.01）是住院死亡率的独立预测因素。
入院时收缩压较低、血浆钠水平较低和肾功能不全的患者住院死亡率增加。
