Cardiology Department, 4th Military Hospital, Wroclaw, Poland.
Kardiol Pol. 2011;69(10):997-1005.
Acute heart failure (HF) is an emerging problem in clinical practice, associated with high in-hospital mortality and a high short-term readmission rate.
To describe the clinical characteristics and define predictors of in-hospital mortality in patients with acute HF.
We conducted a prospective registry of all consecutive patients hospitalised due to acute HF from October 2008 to November 2009 in a single cardiology centre. Clinical status and laboratory parameters were analysed on admission and after 48 h.
We examined 270 patients (age 68 ± 13 years, 71% men, 27% with de novo acute HF, 55% with ischaemic aetiology, 56% with decompensated chronic HF, 80% with warm-wet haemodynamic profile). In-hospital mortality was 8.5% (n = 23). There were no differences between survivors vs non-survivors regarding age, gender, HF aetiology, prevalence of de novo acute HF, and baseline heart rate and body weight values and changes of these parameters during hospitalisation (p > 0.2 for all comparisons). Cardiogenic shock and isolated right-sided HF were more common in patients who died as compared to survivors (17% vs 1% and 22% vs 2%, respectively; p < 0.001), as were the cold-wet and cold-dry haemodynamic profiles (22% vs 2% and 17% vs 1%, respectively; p < 0.001). The most common factor precipitating decompensation in non-survivors was an acute coronary syndrome (17% vs 7%), while elevation of blood pressure and inadequate diuretic therapy were the most common causes of acute HF in survivors (26% vs 4% and 45% vs 22%, respectively; p < 0.05). Baseline mean blood pressure and serum Na(+) level were higher in survivors than in non-survivors (94 ± 20 vs 79 ± 19 mm Hg and 140 ± 4 vs 136 ± 5 mmol/L, respectively; p < 0.001) and both remained higher during follow-up. There were no differences in baseline haemoglobin and serum K(+) levels between these groups. Haemoglobin level decreased after 48 h of therapy only in patients who died (11.1 ± 2.4 vs 12.5 ± 2.1 g/dL; p < 0.01), whereas a reduction in serum K(+) level after 48 h was observed only in survivors (4.2 ± 0.6 vs 3.9 ± 0.5 mmol/L; p < 0.05), probably reflecting effective diuretic therapy. Baseline renal function was more impared in non-survivors (serum creatinine 1.7 [1, 2.5] vs 1.2 [1, 1.6] mg/dL, and blood urea nitrogen 40 [24, 65] vs 24 [19, 33] mg/dL; p < 0.05) and deteriorated further during hospitalisation (serum creatinine 2.0 [1.2, 2.5] vs 1.2 [0.9, 1.5] mg/dL, blood urea nitrogen 64 [45, 77] vs 27 [19, 36] mg/dL; p < 0.01). Baseline plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level did not differentiate these two groups, but plasma NT-proBNP level measured after 48 h was lower in survivors compared to non- -survivors (3560 [1711, 6738] vs 11780 [5371, 18912] pg/mL; p < 0.01); data are shown as medians [lower, upper quartile].
In our registry, in-hospital mortality in patients admitted due to acute HF was slightly higher compared to other reports. Baseline values of some parameters (e.g. blood pressure, serum Na(+), renal function) as well as their changes during hospitalisation (e.g. serum K(+), renal function, plasma NT-proBNP) can help identify acute HF patients at a higher risk of in-hospital mortality.
急性心力衰竭（HF）是临床实践中出现的一个新问题，与院内死亡率高和短期再入院率高有关。
描述急性 HF 患者的临床特征并确定院内死亡率的预测因素。
我们对 2008 年 10 月至 2009 年 11 月期间在一家单一心脏病中心因急性 HF 住院的所有连续患者进行了前瞻性登记。入院时和 48 小时后分析临床状况和实验室参数。
我们检查了 270 名患者（年龄 68 ± 13 岁，71%为男性，27%为新发急性 HF，55%为缺血性病因，56%为失代偿性慢性 HF，80%为温暖湿润的血流动力学特征）。院内死亡率为 8.5%（n = 23）。幸存者和非幸存者在年龄、性别、HF 病因、新发急性 HF 的发生率、入院时的基础心率和体重值以及住院期间这些参数的变化方面没有差异（p > 0.2 所有比较）。心源性休克和孤立的右侧 HF 在死亡患者中比幸存者更常见（17%比 1%和 22%比 2%；p < 0.001），冷湿和冷干血流动力学特征也是如此（22%比 2%和 17%比 1%；p < 0.001）。非幸存者中最常见的病情恶化因素是急性冠状动脉综合征（17%比 7%），而幸存者中急性 HF 最常见的原因是血压升高和利尿剂治疗不当（26%比 4%和 45%比 22%；p < 0.05）。幸存者的基线平均血压和血清 Na(+)水平高于非幸存者（94 ± 20 比 79 ± 19 mm Hg 和 140 ± 4 比 136 ± 5 mmol/L；p < 0.001），并且在随访期间仍保持较高水平。两组间的基线血红蛋白和血清 K(+)水平无差异。只有死亡患者的血红蛋白水平在治疗后 48 小时下降（11.1 ± 2.4 比 12.5 ± 2.1 g/dL；p < 0.01），而幸存者在治疗后 48 小时血清 K(+)水平下降（4.2 ± 0.6 比 3.9 ± 0.5 mmol/L；p < 0.05），可能反映了有效的利尿剂治疗。非幸存者的基线肾功能更差（血清肌酐 1.7 [1, 2.5] 比 1.2 [1, 1.6] mg/dL 和血尿素氮 40 [24, 65] 比 24 [19, 33] mg/dL；p < 0.05），并且在住院期间进一步恶化（血清肌酐 2.0 [1.2, 2.5] 比 1.2 [0.9, 1.5] mg/dL 和血尿素氮 64 [45, 77] 比 27 [19, 36] mg/dL；p < 0.01）。基线血浆 N 末端 proB 型利钠肽（NT-proBNP）水平不能区分这两组，但与非幸存者相比，幸存者在治疗后 48 小时的血浆 NT-proBNP 水平较低（3560 [1711, 6738] 比 11780 [5371, 18912] pg/mL；p < 0.01）；数据显示为中位数[下四分位数，上四分位数]。
在我们的登记处，因急性 HF 住院的患者的院内死亡率略高于其他报告。一些参数的基线值（例如血压、血清 Na(+)、肾功能）以及它们在住院期间的变化（例如血清 K(+)、肾功能、血浆 NT-proBNP）可以帮助识别院内死亡率较高的急性 HF 患者。
