Servicio de Medicina Interna, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain; University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Int J Cardiol. 2018 May 1;258:185-191. doi: 10.1016/j.ijcard.2018.01.067.
Congestion is the main reason for hospital admission for acute decompensated heart failure (ADHF). A better understanding of the clinical course of congestion and factors associated with decongestion are therefore important. We studied the clinical course, predictors and prognostic value of congestion in a cohort of patients admitted for ADHF by including different indirect markers of congestion (residual clinical congestion, brain natriuretic peptides (BNP) trajectories, hemoconcentration or diuretic response).
We studied the prognostic value of residual clinical congestion using an established composite congestion score (CCS) in 1572 ADHF patients. At baseline, 1528 (97.2%) patients were significantly congested (CCS ≥ 3), after 7 days of hospitalization or discharge (whichever came first), 451 (28.7%) patients were still significantly congested (CCS ≥ 3), 751 (47.8%) patients were mildly congested (CCS = 1 or 2) and 370 (23.5%) patients had no signs of residual congestion (CCS = 0). The presence of significant residual congestion at day 7 or discharge was independently associated with increased risk of re-admissions for heart failure by day 60 (HR [95%CI] = 1.88 [1.39-2.55]) and all-cause mortality by day 180 (HR [95%CI] = 1.54 [1.16-2.04]). Diuretic response provided added prognostic value on top of residual congestion and baseline predictors for both outcomes, yet gain in prognostic performance was modest.
Most patients with acute decompensated heart failure still have residual congestion 7 days after hospitalization. This factor was associated with higher rates of re-hospitalization and death. Decongestion surrogates, such as diuretic response, added to residual congestion, are still significant predictors of outcomes, but they do not provide meaningful additive prognostic information.
充血是急性失代偿性心力衰竭（ADHF）患者住院的主要原因。因此，更好地了解充血的临床过程和与充血消退相关的因素非常重要。我们通过纳入不同的间接充血标志物（残余临床充血、脑利钠肽（BNP）轨迹、血液浓缩或利尿剂反应），研究了 ADHF 患者入院时充血的临床过程、预测因素和预后价值。
我们使用既定的综合充血评分（CCS）研究了 1572 例 ADHF 患者的残余临床充血的预后价值。基线时，1528 例（97.2%）患者存在明显充血（CCS≥3），住院或出院后 7 天（以先发生者为准），451 例（28.7%）患者仍存在明显充血（CCS≥3），751 例（47.8%）患者存在轻度充血（CCS=1 或 2），370 例（23.5%）患者无残余充血迹象（CCS=0）。第 7 天或出院时存在明显残余充血与第 60 天因心力衰竭再入院的风险增加独立相关（HR[95%CI]=1.88[1.39-2.55]）和第 180 天全因死亡率增加（HR[95%CI]=1.54[1.16-2.04]）。利尿剂反应在残余充血和基线预测因素的基础上，为这两种结局提供了额外的预后价值，但预后性能的提高幅度较小。
大多数急性失代偿性心力衰竭患者在住院 7 天后仍存在残余充血。这一因素与更高的再入院率和死亡率相关。利尿剂反应等充血消退替代指标与残余充血一起，仍然是结局的重要预测指标，但它们并不能提供有意义的附加预后信息。
