[心力衰竭住院患者死亡率的预后因素]

[Prognostic factors on mortality in patients admitted to hospital with heart failure].

作者信息

Valdivia-Marchal M, Zambrana-Luque J L, Girela-López E, Font-Ugalde P, Salcedo-Sánchez M C, Zambrana-García J L

机构信息

Servicio de Medicina Interna. Hospital de Montilla, Montilla (Córdoba). Agencia Sanitaria Alto Guadalquivir..

出版信息

An Sist Sanit Navar. 2020 Apr 20;43(1):57-67. doi: 10.23938/ASSN.0753.

DOI:10.23938/ASSN.0753

PMID:32242548

Abstract

BACKGROUND

Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF.

METHODS

Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed.

RESULTS

In-hospital mortality was 16%.The independent predictors were: age >75 years (HR?=?2.68, 95%?IC: 1.65-4.36, p?=?0.001); cognitive impairment (HR?=?2.77, 95%?IC: 1.40-5.48, p?=?0.004); Barthel index =60 (HR?=?0.54, 95%?IC: 0.37-0.78, p?=?0,009); creatinine levels >1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?<0.001); cognitive impairment (HR?=?2.45, 95%?IC: 1.22-4.90, p?=?0.011); creatinine levels >1.16 mg/dl on admission (HR?=?1.59, 95%?IC: 1.12-2.24, p?=?0.009); systolic blood pressure >140 mm Hg on admission (HR?=?0.56, 95%?IC: 0.40-0.80, p?<0.001); and number of diagnostics >10 on discharge (HR?=?1. 49, 95%?IC: 1.03-2.16, p?=?0.033).

CONCLUSIONS

Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF.

摘要

背景

心力衰竭（HF）是西方国家老年人群住院治疗的主要原因，且死亡率呈上升趋势。本研究旨在评估因心力衰竭入院患者可能的长期死亡风险因素。

方法

对一组202例因心力衰竭连续住院且随访最长5年的患者进行回顾性研究。分析临床和流行病学因素及其与住院期间和长期死亡率的关系。

结果

住院死亡率为16%。独立预测因素为：年龄>75岁（HR = 2.68，95%CI：1.65 - 4.36，p = 0.001）；认知障碍（HR = 2.77，95%CI：1.40 - 5.48，p = 0.004）；Barthel指数≤60（HR = 0.54，95%CI：0.37 - 0.78，p = 0.009）；入院时肌酐水平>1.16 mg/dl（HR = 1.57，95%CI：1.12 - 2.20，p = 0.009）；出院时诊断项目数>10项（HR = 1.64，95%CI：1.14 - 2.36，p = 0.007）。出院后12、24、36和48个月的累积死亡率分别为43%、51%、67%和70%；其独立预测因素为：年龄>75岁（HR = 2.55，95%CI：1.56 - 4.15，p <0.001）；认知障碍（HR = 2.45，95%CI：1.22 - 4.90，p = 0.011）；入院时肌酐水平>1.16 mg/dl（HR = 1.59，95%CI：1.12 - 2.24，p = 0.009）；入院时收缩压>140 mmHg（HR = 0.56，95%CI：0.40 - 0.80，p <0.001）；出院时诊断项目数>10项（HR = 1.49，95%CI：1.03 - 2.16，p = 0.033）。