Moleerergpoom Worachat, Hengrussamee Kriengrai, Piyayotai Dilok, Jintapakorn Woravut, Sukhum Pradub, Kunjara-Na-Ayudhya Rapeephon, Suwanjutah Thouantosaporn, Laothavorn Prasart
Division of Cardiology, Department of Medicine, Police General Hospital, Pathumwan, Bangkok, Thailand.
J Med Assoc Thai. 2013 Feb;96(2):157-64.
Heart failure had emerged as a major public health problem and became the leading cause of hospitalization. The Acute Decompensated Heart Failure National Registry (ADHERE) of US patients hospitalized with a primary diagnosis of acute decompensated heart Failure (ADHF) had been reported worldwide for the risk stratification and predicting In-hospital mortality.
Identify clinical risk factors or treatment procedures that could predict In-hospital mortality in Thai patients with ADHF.
Thai ADHERE is a multicenter, observational, prospective study. The data were collected via web-based electronic data capture and analyzed. Two thousand forty one hospitalization episodes involving 1,671 patients in the 18 participating hospitals between March 2006 and September 2007 were analyzed. All clinical factors associated with In-hospital mortality identified by univariated analysis were further analyzed by Logistic regression model.
One hundred thirteen patients died during the hospitalization period with overall mortality rate of 5.5%. Systolic blood pressure < 90 mmHg, creatinine > 2.0 mg/dL, history of stroke/TIA, and NYHA class IV were independent risk factors for In-hospital mortality with adjusted OR (95% CI) = 3.45 (1.77-6.79), 1.99 (1.30-3.05), 1.85 (1.11-3.08) and 1.69 (1.08-2.64) respectively. Hypertensive cause of CHF, prior use of lipid lowering drug, and hemoglobin level were associated with lower risk, adjusted OR (95% CI) = 0.35 (0.15-0.81), 0.51 (0.34-0.78) and 0.90 (0.82-0.98) respectively.
The clinical predictors for In-hospital mortality of Thai ADHERE that associated with worse outcome were systolic blood pressure < 90 mmHg, creatinine > 2.0 mg/dL, history of stroke/TIA, and NYHA class IV. Hypertensive cause of CHF, prior use of lipid lowering drug, and hemoglobin were associated favorable outcome.
心力衰竭已成为一个主要的公共卫生问题，并成为住院的主要原因。美国急性失代偿性心力衰竭国家注册研究（ADHERE）对以急性失代偿性心力衰竭（ADHF）为主要诊断住院的患者进行了报道，该研究用于风险分层和预测住院死亡率，并在全球范围内得到了广泛关注。
确定可预测泰国ADHF患者住院死亡率的临床危险因素或治疗措施。
泰国ADHERE研究是一项多中心、观察性、前瞻性研究。数据通过基于网络的电子数据采集系统收集并进行分析。对2006年3月至2007年9月期间18家参与医院的1671例患者的2041次住院情况进行了分析。对单因素分析确定的所有与住院死亡率相关的临床因素，进一步采用Logistic回归模型进行分析。
113例患者在住院期间死亡，总死亡率为5.5%。收缩压<90 mmHg、肌酐>2.0 mg/dL、中风/TIA病史和纽约心脏协会（NYHA）IV级是住院死亡率的独立危险因素，校正后的比值比（95%可信区间）分别为3.45（1.77 - 6.79）、1.99（1.30 - 3.05）、1.85（1.11 - 3.08）和1.69（1.08 - 2.64）。CHF的高血压病因、既往使用降脂药物和血红蛋白水平与较低风险相关，校正后的比值比（95%可信区间）分别为0.35（0.15 - 0.81）、0.51（0.34 - 0.78）和0.90（0.82 - 0.98）。
泰国ADHERE研究中与不良预后相关的住院死亡率临床预测因素为收缩压<90 mmHg、肌酐>2.0 mg/dL、中风/TIA病史和NYHA IV级。CHF的高血压病因、既往使用降脂药物和血红蛋白与良好预后相关。
