Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain.
Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Rev Clin Esp (Barc). 2022 Jun-Jul;222(6):321-331. doi: 10.1016/j.rceng.2021.07.004. Epub 2021 Oct 29.
This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for predicting short-term progress.
The study group comprised consecutive patients diagnosed with AHF in 45 HED from EAHFE Registry. We collected clinical variables of systemic congestion (edema in the lower extremities, jugular vein distention, hepatomegaly) and pulmonary congestion (dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary crackles) and analysed their individual and group association with all-cause 30-day of mortality crudely and adjusted for differences between groups.
We analysed 18,120 patients (median = 83 years, interquartile range [IQR] = 76-88; women = 55.7%). Of them, 44.6% had > 3 congestive symptoms/signs. Individually, the 30-day adjusted risk of death increased 14% for jugular vein distention (hazard ratio [HR] = 1.14, 95% confidence interval [95%CI] = 1.01-1.28) and 96% for dyspnea on exertion (HR = 1.96, 95% CI = 1.55-2.49). Assessed jointly, the risk progressively increased with the number of symptoms/signs present; compared to patients without symptoms/signs of congestion, the risk increased by 109%, 123 %, and 156% in patients with 1-2, 3-5, and 6-7 symptoms/signs, respectively. These associations did not show interaction with the final disposition of the patient after their emergency care (discharge/hospitalization) with the exception of edema in the lower extremities, which had a better prognosis in discharged patients (HR = 0.66, 95% CI = 0.49-0.89) than hospitalised patients (HR = 1.01, 95% CI = 0.65-1.57; interaction p < 0.001).
The presence of a greater number of congestive symptoms/signs was associated with greater all-cause 30-day mortality. Individually, jugular vein distention and dyspnea on exertion were associated with higher short-term mortality.
本研究旨在评估急性心力衰竭（AHF）患者在医院急诊部（HED）出现的症状/体征是否能够预测短期预后。
该研究纳入了来自 EAHFE 登记处的 45 个 HED 中连续诊断为 AHF 的患者。我们收集了全身充血（下肢水肿、颈静脉扩张、肝肿大）和肺充血（劳力性呼吸困难、阵发性夜间呼吸困难、端坐呼吸和肺部湿啰音）的临床变量，并分析了它们与全因 30 天死亡率的个体和组间关联，同时对组间差异进行了调整。
我们分析了 18120 名患者（中位数=83 岁，四分位距 [IQR]=76-88；女性占 55.7%）。其中，44.6%的患者有>3 种充血症状/体征。个体上，颈静脉扩张的 30 天死亡调整风险增加了 14%（危险比 [HR]=1.14，95%置信区间 [95%CI]=1.01-1.28），劳力性呼吸困难增加了 96%（HR=1.96，95%CI=1.55-2.49）。联合评估时，随着症状/体征数量的增加，风险逐渐增加；与无充血症状/体征的患者相比，有 1-2、3-5 和 6-7 种症状/体征的患者的风险分别增加了 109%、123%和 156%。这些关联在患者急诊治疗后（出院/住院）的最终转归方面没有表现出交互作用，除了下肢水肿，出院患者的预后更好（HR=0.66，95%CI=0.49-0.89），而住院患者的预后更差（HR=1.01，95%CI=0.65-1.57；交互作用 p<0.001）。
出现更多充血症状/体征与全因 30 天死亡率增加相关。颈静脉扩张和劳力性呼吸困难与短期死亡率升高有关。
