Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
ESC Heart Fail. 2024 Aug;11(4):2249-2258. doi: 10.1002/ehf2.14792. Epub 2024 Apr 17.
Acute heart failure (AHF) can result in worsening of heart failure (WHF), cardiogenic shock (CS), or death. Risk factors for these adverse outcomes are not well characterized. This study aimed to identify predictors for WHF or new-onset CS in patients hospitalized for AHF.
Prospective cohort study enrolling consecutive patients with AHF admitted to a large tertiary care centre with follow-up until death or discharge. WHF was defined by the RELAX-AHF-2 criteria. CS was defined as SCAI stages B-E. Potential predictors were assessed by fitting logistic regression models adjusted for age and sex. N = 233 patients were enrolled, median age was 78 years, and 80 were women (35.9%). Ischaemic cardiomyopathy was present in 82 patients (40.8%). Overall, 96 (44.2%) developed WHF and 18 (9.7%) CS. In-hospital death (8/223, 3.6%) was related to both events (WHF: OR 6.64, 95% CI 1.21-36.55, P = 0.03; CS: OR 38.27, 95% CI 6.32-231.81, P < 0.001). Chronic kidney disease (OR 2.20, 95% CI 1.25-3.93, P = 0.007), logarithmized serum creatinine (OR 2.90, 95% CI 1.51-5.82, P = 0.002), cystatin c (OR 1.86, 95% CI 1.27-2.77, P = 0.002), tricuspid valve regurgitation (OR 2.08, 95% CI 1.11-3.94, P = 0.023) and logarithmized pro-adrenomedullin (OR 3.01, 95% CI 1.75-5.38, P < 0.001) were significant predictors of WHF. Chronic kidney disease (OR 3.17, 95% CI 1.16-9.58, P = 0.03), cystatin c (OR 1.88, 95% CI 1.00-3.53, P = 0.045), logarithmized pro-adrenomedullin (OR 2.90, 95% CI 1.19-7.19, P = 0.019), and tricuspid valve regurgitation (OR 10.44, 95% CI 2.61-70.00, P = 0.003) were significantly with new-onset CS.
Half of patients admitted with AHF experience WHF or new-onset CS. Chronic kidney disease, tricuspid valve regurgitation, and elevated pro-adrenomedullin concentrations predict these events. They could potentially serve as early warning signs for further deterioration in AHF patients.
急性心力衰竭（AHF）可导致心力衰竭恶化（WHF）、心源性休克（CS）或死亡。这些不良结局的风险因素尚未得到很好的描述。本研究旨在确定因 AHF 住院患者发生 WHF 或新发 CS 的预测因素。
前瞻性队列研究纳入了连续入住大型三级护理中心的 AHF 患者，并进行随访，直至死亡或出院。WHF 采用 RELAX-AHF-2 标准定义。CS 定义为 SCAI 分期 B-E。通过拟合调整年龄和性别的逻辑回归模型评估潜在预测因素。共纳入 233 例患者，中位年龄为 78 岁，80 例女性（35.9%）。82 例（40.8%）存在缺血性心肌病。总体而言，96 例（44.2%）发生 WHF，18 例（9.7%）发生 CS。院内死亡（8/223，3.6%）与这两个事件有关（WHF：OR 6.64，95%CI 1.21-36.55，P=0.03；CS：OR 38.27，95%CI 6.32-231.81，P<0.001）。慢性肾脏病（OR 2.20，95%CI 1.25-3.93，P=0.007）、血清肌酐对数（OR 2.90，95%CI 1.51-5.82，P=0.002）、胱抑素 C（OR 1.86，95%CI 1.27-2.77，P=0.002）、三尖瓣反流（OR 2.08，95%CI 1.11-3.94，P=0.023）和前肾上腺髓质素对数（OR 3.01，95%CI 1.75-5.38，P<0.001）是 WHF 的显著预测因素。慢性肾脏病（OR 3.17，95%CI 1.16-9.58，P=0.03）、胱抑素 C（OR 1.88，95%CI 1.00-3.53，P=0.045）、前肾上腺髓质素对数（OR 2.90，95%CI 1.19-7.19，P=0.019）和三尖瓣反流（OR 10.44，95%CI 2.61-70.00，P=0.003）与新发 CS 显著相关。
一半因 AHF 住院的患者会出现 WHF 或新发 CS。慢性肾脏病、三尖瓣反流和前肾上腺髓质素浓度升高可预测这些事件。它们可能成为 AHF 患者病情进一步恶化的早期预警信号。
