常规实验室检查结果与急性失代偿性心力衰竭住院后 30 天和 1 年的死亡率风险。

INTRODUCTION

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).

DISCUSSION

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.

简介

在因急性失代偿性心力衰竭住院的患者中，通常会进行多项血液检查，这些检查可预测患者的预后：全血细胞计数、电解质、肾功能、血糖、白蛋白和尿酸。我们旨在评估入院常规实验室检查结果、患者特征与 30 天和 1 年死亡率之间的关系，并构建一种简单的死亡率预测工具。

方法

这是一项回顾性的基于人群的研究。研究数据来自以色列 2002-2005 年期间七家三级医院所有因心力衰竭住院的患者，主要诊断为心力衰竭。

结果

本研究共纳入 8246 例患者。30 天死亡率为 8.5%（701 例），1 年死亡率为 28.7%（2365 例）。在一组临床和人口统计学特征的基础上，加入 5 项常规实验室检查结果（白蛋白、钠、血尿素、尿酸和白细胞计数），可提高 30 天的 C 统计量（从 0.76 提高到 0.81，p 值均<0.0001）和 1 年死亡率预测的 C 统计量（从 0.72 提高到 0.76，p 值均<0.0001）。3 种异常实验室结果（低白蛋白血症、低钠血症和血尿素升高）的二分法异常结果具有最高的 1 年死亡率比值比，可用于构建一种简单的预测评分，该评分在 30 天死亡率方面可将患者分为 0 分（1477 例）和 3 分（544 例），差异为 1.1%~~21.4%，在 1 年死亡率方面可将患者分为 0 分（1477 例）和 3 分（544 例），差异为 11.6%~~55.6%。