Velasco Malagón Sergio, Acosta-Gutiérrez Estivalis, Atilio Nuñez Ramos José, Salinas Sebastián, Mora Pabón Guillermo
Universidad Nacional de Colombia Bogotá COL.
Department of Internal Medicine, Clínica Nueva El Lago Bogotá COL.
POCUS J. 2024 Nov 15;9(2):125-132. doi: 10.24908/pocus.v9i2.17709. eCollection 2024.
Heart failure (HF) is a complex entity that increases the risk of adverse outcomes. Point of care ultrasound (POCUS) allows easy lung and systemic venous congestion identification. Using ultrasound to detect sub-clinical congestion at discharge may help predict readmissions and mortality. The primary outcome was to address 30-day rehospitalization, and as a secondary outcome we investigated readmission and mortality in patients with residual congestion assessed with POCUS. A prospective prognostic cohort study was conducted at a tertiary-level institution in Colombia. Patients with acute decompensated heart failure (ADHF) at discharge were evaluated using POCUS through lung ultrasound (LUS), portal vein pulsatility (PVP), and a composite assessment of residual congestion. Inclusion criteria were ADHF, over 18 years old, with a "warm-wet" clinical profile. POCUS was performed using an ultraportable device using LUS and PVP. Statistical analysis used logistic regression models to estimate the association between ultrasound congestion and outcomes. A total of100 patients were included. The population was mostly female, with a median age of 78 years; 59% were hypertensive, and 39% had type 2 diabetes. Median NT-ProBNP was 3878 pg/ml. At discharge, 55% of patient had an inferior vena cava (IVC) over 2 cm, 54% had interstitial syndrome, and 41% had PVP >30%. Regarding 30-day readmission, we found an odds ratio (OR) 7.22 (95% CI 2.7-19.3) for interstitial syndrome; for PVP >30%, an OR 24.61 (95% CI 7.7-78.1) and an OR 13.19 (95% CI 2.7-62.6) for composite of residual congestion. Patients with ADHF and sub-clinical congestion, evidenced in LUS and PVP, were more likely to have readmission within 30 days of discharge. These findings should be confirmed with clinical trials to assess the effectiveness of a POCUS-guided treatment.
心力衰竭（HF）是一种复杂的病症，会增加不良后果的风险。床旁超声（POCUS）能够轻松识别肺部和体循环静脉充血情况。利用超声在出院时检测亚临床充血可能有助于预测再入院率和死亡率。主要结局是解决30天内再入院问题，作为次要结局，我们调查了通过POCUS评估有残余充血的患者的再入院率和死亡率。在哥伦比亚的一家三级医疗机构进行了一项前瞻性预后队列研究。对出院时的急性失代偿性心力衰竭（ADHF）患者通过肺部超声（LUS）、门静脉搏动性（PVP）以及残余充血的综合评估，使用POCUS进行评估。纳入标准为ADHF、年龄超过18岁、具有“暖湿型”临床特征。使用超便携式设备通过LUS和PVP进行POCUS检查。统计分析采用逻辑回归模型来估计超声充血与结局之间的关联。总共纳入了100名患者。研究人群以女性为主，中位年龄为78岁；59%为高血压患者，39%患有2型糖尿病。NT-ProBNP中位数为3878 pg/ml。出院时，55%的患者下腔静脉（IVC）超过2 cm，54%有间质综合征，41%的患者PVP>30%。关于30天再入院情况，我们发现间质综合征的比值比（OR）为7.22（95%置信区间2.7 - 19.3）；对于PVP>30%，OR为24.61（95%置信区间7.7 - 78.1），残余充血综合情况的OR为13.19（95%置信区间2.7 - 62.6）。在LUS和PVP中表现出亚临床充血的ADHF患者在出院后30天内更有可能再次入院。这些发现应通过临床试验进行确认，以评估POCUS引导治疗的有效性。
