The Relationship between Phenotypic Classification and Inflammatory Parameters in Patients Hospitalized with Acute Heart Failure

Aim    To evaluate the effects of inflammatory parameters on mortality and prognosis in patients who were hospitalized with acute heart failure (AHF) and phenotypically classified.
Material and methods    Between December 2020 and August 2021, 240 patients, who were newly diagnosed with acute heart failure (AHF) or those with heart failure and who developed decompensation, were prospectively included in the study. The patients composed four equal groups of 60 patients each according to the phenotypical class of AHF: warm-wet, warm-dry, cold-wet, and cold-dry. Acute phase reactants, namely C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma albumin, were examined at hospitalization, discharge, and 30±7 days after discharge. The reactants were compared between the groups in terms of mortality and prognosis.
Results    Univariate analyses showed that, at the time of initial hospitalization, a one-unit increase in albumin decreased the mortality risk 0.794‑fold, while a one-unit increase in CRP increased the mortality risk 1.013‑fold and a one-unit increase in ESR increased the mortality risk 1.026‑fold (p<0.001, p=0.003, and p=0.002, respectively). At discharge, a one-unit increase in albumin decreased the mortality risk 0.85‑fold (p=0.043). However, multivariate analyses showed that, at the time of initial hospitalization, a one-unit increase in albumin decreased the mortality risk 0.803‑fold, while a one-unit increase in the ESR value increased the mortality risk 1.021‑fold (p<0.001 and p=0.049, respectively). Although a statistically significant difference was observed between the warm-dry group and the other groups in terms of in-hospital mortality distributions (p=0.032), there was no statistically significant difference between the groups in terms of out-of-hospital mortality (p>0.050).
Conclusion    In AHF patients, low albumin values at initial hospitalization and discharge, high CRP and ESR values at initial hospitalization predict increased mortality.

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