Kone Alpha, Cherif Mahamoud Sama, Prabin Dahal, Dumre Shyam Prakash, Doumbouya Almamy Ibrahim, Kapche Diane Fotso, Camara Facely, Saousan Serbout, Sara Khaddi, Diakite Mandiou, Cisse Mohamed, Azzouzi Leila, Habbal Rachida
Department of Cardiology, Ibn Rochd Hospital, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.
Pan Afr Med J. 2019 Sep 3;34:6. doi: 10.11604/pamj.2019.34.6.17998. eCollection 2019.
Heart Failure (HF) is a growing public health concern in Morocco and there is a striking paucity on determinants of severe HF (SHF) in this population. The aim of this study was to identify patients admitted with HF at Ibn Rochd Hospital, Casablanca from 2011 onwards, when electronic record keeping began.
A total of 105 patients underwent a series of cardiological examinations between July 2011 and January 2014. The New York Heart Association (NYHA) criteria was used to evaluate the severity of HF. Patients with NYHA classification gradings of I and II were defined as having moderate HF (MHF) and those graded as III and IV were defined as having a SHF. Univariable and multivariable risk factors associated with SHF were explored using logistic regression. The results were reported following the RECORD (Reporting of studies Conducted using Observational Routinely-collected Data) statement.
A total of 24 (33%) patients were identified as having a SHF. Four predictors of SHF were identified in univariate analysis: haemoglobin <12g/dL, neutrophil-to-lymphocyte ratio (NLR) >3, mean corpuscular haemoglobin concentration (MCHC) <32 picolitre, and high density lipoprotein (HDL) <0.35 (mmol/L). Only NLR>3 and HDL <0.35 mmol/L remained independent predictors in multivariable analysis. Patients with NLR >3 were at 6-fold increased odds of SHF [adjusted odds ratio (AOR): 6.78, 95% confidence interval (CI): 1.40-32.80, p=0.017], and those with HDL<0.35 (mmol/L) were at 10-fold increased odds of SHF [AOR: 10.11, 95% CI: 2.26-45.27, p=0.002].
The independent biomarkers of SHF identified in this study provide valuable information to ward clinicians in resource-constrained facilities to identify patients vulnerable to developing severe heart complications.
心力衰竭（HF）在摩洛哥正日益引起公共卫生领域的关注，而关于该人群中严重心力衰竭（SHF）的决定因素的研究却极为匮乏。本研究的目的是确定自2011年起卡萨布兰卡伊本·罗奇德医院开始采用电子记录保存后收治的心力衰竭患者。
2011年7月至2014年1月期间，共有105例患者接受了一系列心脏检查。采用纽约心脏协会（NYHA）标准评估心力衰竭的严重程度。NYHA分级为I级和II级的患者被定义为患有中度心力衰竭（MHF），而分级为III级和IV级的患者被定义为患有SHF。使用逻辑回归分析与SHF相关的单变量和多变量危险因素。研究结果按照RECORD（使用常规收集的观察性数据进行研究的报告）声明进行报告。
共有24例（33%）患者被确定为患有SHF。单变量分析确定了SHF的四个预测因素：血红蛋白<12g/dL、中性粒细胞与淋巴细胞比值（NLR）>3、平均红细胞血红蛋白浓度（MCHC）<32皮升，以及高密度脂蛋白（HDL）<0.35（mmol/L）。多变量分析中，只有NLR>3和HDL<0.35 mmol/L仍然是独立预测因素。NLR>3的患者发生SHF的几率增加了6倍[调整后的优势比（AOR）：6.78，95%置信区间（CI）：1.40 - 32.80，p = 0.017]，而HDL<0.35（mmol/L）的患者发生SHF的几率增加了10倍[AOR：10.11，95% CI：2.26 - 45.27，p = 0.002]。
本研究中确定的SHF独立生物标志物为资源有限机构的病房临床医生提供了有价值的信息，以识别易发生严重心脏并发症的患者。
