Department of Cardiology, BooAli Hospital, Azad University of Medical Sciences, Tehran, Iran.
Independent Researcher, Tehran, Iran.
J Clin Lab Anal. 2024 Nov;38(21):e25109. doi: 10.1002/jcla.25109. Epub 2024 Oct 4.
Heart failure (HF) is a common condition that imposes a significant burden on healthcare systems. We aimed to identify subgroups of patients with heart failure admitted to the ICU using routinely measured laboratory biomarkers.
A large dataset (N = 1176) of patients with heart failure admitted to the ICU at the Beth Israel Deaconess Medical Center in Boston, USA, between June 1, 2001, and October 31, 2012, was analyzed. We clustered patients to identify laboratory phenotypes. Cluster profiling was then performed to characterize each cluster, using a binary logistic model.
Two distinct clusters of patients were identified (N = 679 and 497). There was a significant difference in the mortality rate between Clusters 1 and 2 (50 [7.4%] vs. 109 [21.9%], respectively, p < 0.001). Patients in the Cluster 2 were significantly older (mean [SD] age = 72.35 [14.40] and 76.37 [11.61] years, p < 0.001) with a higher percentage of chronic kidney disease (167 [24.6%] vs. 262 [52.7%], respectively, p < 0.001). The logistic model was significant (Log-likelihood ratio p < 0.001, pseudo R = 0.746) with an area under the curve of 0.905. The odds ratio for leucocyte count, mean corpuscular volume (MCV), red blood cell (RBC) distribution width, hematocrit (HcT), lactic acid, blood urea nitrogen (BUN), serum potassium, magnesium, and sodium were significant (all p < 0.05).
Laboratory data revealed two phenotypes of ICU-admitted patients with heart failure. The two phenotypes are of prognostic importance in terms of mortality rate. They can be differentiated using blood cell count, kidney function status, and serum electrolyte concentrations.
心力衰竭（HF）是一种常见病症，会给医疗保健系统带来重大负担。我们旨在使用常规测量的实验室生物标志物来确定入住 ICU 的心力衰竭患者的亚组。
分析了美国波士顿 Beth Israel Deaconess 医疗中心 2001 年 6 月 1 日至 2012 年 10 月 31 日期间收治的 ICU 心力衰竭患者的大型数据集（N=1176）。我们对患者进行聚类以确定实验室表型。然后使用二元逻辑模型对每个聚类进行聚类分析，以对每个聚类进行特征描述。
确定了两个不同的患者群（N=679 和 497）。群 1 和群 2 的死亡率有显著差异（分别为 50 [7.4%]和 109 [21.9%]，p<0.001）。群 2 中的患者年龄明显较大（平均[标准差]年龄分别为 72.35[14.40]和 76.37[11.61]岁，p<0.001），慢性肾脏病的百分比也较高（分别为 167 [24.6%]和 262 [52.7%]，p<0.001）。逻辑模型具有统计学意义（对数似然比 p<0.001，伪 R=0.746），曲线下面积为 0.905。白细胞计数、平均红细胞体积（MCV）、红细胞分布宽度、血细胞比容（HcT）、乳酸、血尿素氮（BUN）、血清钾、镁和钠的比值比均有显著意义（均 p<0.05）。
实验室数据揭示了 ICU 收治的心力衰竭患者的两种表型。这两种表型在死亡率方面具有预后意义。它们可以通过血细胞计数、肾功能状态和血清电解质浓度来区分。
