Prognostic Value of Clinical and Instrumental Characteristics in Determining the Outcome of Patients With Acute Decompensated Heart Failure

Aim        Evaluation of clinical, demographic, laboratory, and instrumental characteristics of patients with acute decompensated heart failure (ADHF) depending on the outcome over the hospitalization period.

Material and methods    The prevalence of chronic heart failure (CHF) and ADHF remains extremely high. Hospitalization for ADHF is the most important predictor of death and readmission in the long term, and each subsequent hospitalization significantly increases the risk of death. Research of in-hospital mortality in this group of patients is limited in the Russian literature; however, numerous studies have examined mortality at 30, 60, and more days after discharge. This comprehensive retrospective study included patients aged >18 years who were hospitalized for ADHF in a multidisciplinary hospital from December 1, 2019 through December 1, 2021. Patients were divided into two groups based on their outcomes during their hospital stay. Laboratory, clinical, and instrumental characteristics were assessed with subsequent multivariate data analysis. Statistical analysis was performed using an IBM SPSS Statistics version 24.0 software.

Results  During the observation period, 498 patients were included. In-hospital mortality was 8% (n=41). According to the results of binary logistic regression, the need for inotropic drugs (odds ratio (OR) 94.6; 95% confidence interval (CI): 19.8-451; p<0.001), presence of an infectious disease requiring antimicrobial therapy (OR 6.6; 95% CI 1.5-29; p=0.01), an increase in high-sensitivity troponin >99th percentile on admission (OR 6.1; 95% CI: 1.35-28.1; p=0.01), and systolic blood pressure <110 mmHg. (OR 4.2; 95% CI 1.06-16.6; p=0.01) were directly associated with the likelihood of death during the hospital stay. The resulting regression model was statistically significant (p<0.001). Based on the value of the Nigelkirk determination coefficient, the compiled model takes into account 71.1% of the factors that determine the likelihood of death during hospital stay. The sensitivity of the model was 98.6%, the specificity was 74.1%, and the diagnostic efficiency was 96.5%.

Conclusion         Thirty percent of hospitalized patients with ADHF without signs of acute coronary syndrome or other focal pathology had elevated high-sensitivity troponin levels >99th percentile upon admission, which was directly associated with the in-hospital mortality. These patients represent a special group with a poor prognosis during their hospital stay, and myocardial injury markers have a high predictive value for assessing clinical outcomes in this patient population.

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