Basic laboratory parameters as predictors of in-hospital death in patients with acute decompensated heart failure: data from a large single-centre cohort

Ostrowska, Małgorzata; Ostrowski, Adam; Łuczak, Małgorzata; Jaguszewski, Miłosz; Adamski, Piotr; Bellwon, Jerzy; Rynkiewicz, Andrzej; Gruchała, Marcin

doi:10.5603/kp.a2016.0147

Cited by 22 publications

(17 citation statements)

References 23 publications

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“…The three groups were virtually the same in the context of well-established AHF prognostic factors, such as systolic blood pressure, serum sodium, creatinine, NT-proBNP, or troponin level on admission [26][27][28]. This observation may suggest that the prognostic importance of coexisting elevation of lactate and sTfR levels was irrespective of these vital variables.…”

Section: Discussionmentioning

confidence: 98%

Elevated lactate in acute heart failure patients with intracellular iron deficiency as identifier of poor outcome

Biegus¹,

Zymliński²,

Sokolski³

et al. 2019

Kardiol Pol

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Background: We believe that there is a physiological link between intracellular iron status (assessed by soluble transferrin receptor [sTfR]) and efficiency of energy production/consumption (assessed by lactate, a product of anaerobic cell metabolism), which may further impact the outcome of patients with acute heart failure (AHF). Aim: To examine if elevated levels of lactate (> 2 mmol/L) accompanied by unmet cellular iron requirements (defined as sTfR > 1.59 mg/L) identify AHF patients with an unfavourable outcome. Methods: The study is a single-centre, retrospective analysis of AHF patients in whom lactate and iron status were assessed on admission. The endpoint of the study was one-year mortality. Results: The study population consisted of 89 patients at a mean age of 65 ± 13 years. Mean systolic blood pressure and creatinine level were 135 ± 36 mmHg and 1.3 ± 0.6 mg/dL, respectively, and median [25 th-75 th quartiles] lactate level on admission was 2.0 [1.6-2.6] mmol/L. In 17 (19%) patients, both lactate and sTfR were below the cutoff values (group 1). In 38 (43%) individuals one of the markers was elevated (group 2) and in the remaining 34 (38%) patients both markers were above the predefined cutoff values (group 3). There was no difference in clinical and laboratory characteristics between the groups. During one-year follow-up 23 (26%) patients died. Mortality risk in group 3 was higher compared to the rest of the population (hazard ratio 5.6, 95% confidence interval 2.2-14, p = 0.0003), even after adjustments for well-defined prognostic factors. Conclusions: Patients with unmet iron cell requirements and hyperlactataemia on admission have significantly higher mortality risk compared to individuals without those pathologies.

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Section: Discussionmentioning

confidence: 98%

Elevated lactate in acute heart failure patients with intracellular iron deficiency as identifier of poor outcome

Biegus¹,

Zymliński²,

Sokolski³

et al. 2019

Kardiol Pol

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“…In a large cohort of 638 consecutive patients with acute decompensated heart failure, patients with in-hospital death had significantly higher NLR values compared to those discharged home (3.5 (2.3-5.4) compared to 7.7 (4.0-15.3), p < 0.001). Higher NLR values were correlated to in-hospital mortality in both univariate and multivariate analysis [25].…”

Section: In-hospital Mortality After Acute Decompensated Heart Failurementioning

confidence: 89%

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

Delcea

Buzea

Dan

2019

Romanian Journal of Internal Medicine

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Introduction. Heart failure (HF) and systemic inflammation are interdependent processes that continuously potentiate each other. Distinct pathophysiological pathways are activated, resulting in increased neutrophil count and reduced lymphocyte numbers, making the neutrophil to lymphocyte ratio (NLR) a potential indirect marker of severity. We conducted this comprehensive review to characterize the role of NLR in HF. Methods. We searched the PubMed (MEDLINE) database using the key words “neutrophil”, “lymphocyte”, “heart failure”, “cardiomyopathy”, “implantable cardioverter defibrillator”, “cardiac resynchronization therapy” and “heart transplant”. Results. We identified 241 publications. 31 were selected for this review, including 12,107 patients. NLR was correlated to HF severity expressed by clinical, biological, and imaging parameters, as well as to short and long-term prognosis. Most studies reported its survival predictive value. Elevated NLR (>2.1–7.6) was an independent predictor of in-hospital mortality [adjusted HR 1.13 (95% CI 1.01–1.27) – 2.8 (95% CI 1.43–5.53)] as well as long-term all-cause mortality [adjusted HR 1.43 (95% CI 1.1–1.85) – 2.403 (95% CI 1.076–5.704)]. Higher NLR levels also predicted poor functional capacity [NLR > 2.26/2.74, HR 3.93 (95% CI 1.02–15.12) / 3.085 (95% CI 1.52–6.26)], hospital readmissions [NLR > 2.9/7.6, HR 1.46 (95% CI 1.10–1.93) / 3.46 (95% CI 2.11–5.68)] cardiac resynchronization therapy efficacy [NLR > 3.45/unit increase, HR 12.22 (95% CI 2.16–69.05) / 1.51 (95% CI 1.01–2.24)] and appropriate implantable cardioverter defibrillator shocks (NLR > 2.93), as well as mortality after left ventricular assist device implantation [NLR > 4.4 / quartiles, HR 1.67 (95% CI 1.03–2.70) / 1.22 (95% CI 1.01–1.47)] or heart transplant (NLR > 2.41, HR 3.403 (95% CI 1.04–11.14)]. Conclusion. Increased NLR in HF patients can be a valuable auxiliary biomarker of severity, and most of all, of poor prognosis.

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“…The physiological information it carries is also used in endurance sports because intense exercise leads to lactate accumulation even in the absence of any overt pathology [11]. Unlike other widely used markers in heart failure (HF), lactate is unique because it reflects the dynamic energetic/metabolic status of the patient [12][13][14][15][16]. It does not reflect the severity of heart dysfunction itself, but rather the metabolic consequences of the insult driven by the decompensation and its severity in each patient.…”

Section: Introductionmentioning

confidence: 99%

Persistent hyperlactataemia is related to high rates of in-hospital adverse events and poor outcome in acute heart failure

Biegus¹,

Zymliński²,

Gajewski³

et al. 2019

Kardiol Pol

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Background: Although lactate is a well-established marker in intensive care, our understanding of its utility in acute heart failure (AHF) is modest and based on studies with a single measurement of this marker. Aim: We aimed to investigate whether persistent elevation of lactate during hospitalisation is related to a higher risk of adverse events. Methods: We conducted a prospective study to assess AHF patients hospitalised in one cardiac centre. The diagnosis of persistent hyperlactataemia was based on two measurements of the marker (on admission and at 24 h of hospitalisation) and it was defined as lactate elevation (≥ 2 mmol/L) at both time points. Results: The population consisted of 222 patients at a mean age of 70 ± 13 years. Mean ejection fraction and creatinine level on admission were 37% ± 16% and 1.36 ± 0.51 mg/dL, respectively. The percentage of patients with elevated lactates on admission, at 24 h of hospitalisation, and persistent hyperlactataemia were 47%, 35%, and 24%, respectively. The group with persistent hyperlactataemia did not differ in most clinical and laboratory variables from the rest of the population. Patients with persistent hyperlactataemia had higher rate of adverse events during hospitalisation: worsening of heart failure (22.6% vs. 6.5%, p < 0.05), inotrope use (22.6% vs. 5.3%, p < 0.05), and increase of N-terminal pro-B-type natriuretic peptide at 48 h of hospitalisation (30% vs. 18%, p < 0.05). Persistent hyperlactataemia was an independent predictor of one-year mortality (hazard ratio 2.5, 95% confidence interval 1.5-4.3, p < 0.001). Conclusions: Persistent hyperlactataemia within the first 24 h of hospitalisation is a predictor of a worse outcome in AHF and is related to higher rates of in-hospital adverse events and one-year mortality.

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Basic laboratory parameters as predictors of in-hospital death in patients with acute decompensated heart failure: data from a large single-centre cohort

Cited by 22 publications

References 23 publications

Elevated lactate in acute heart failure patients with intracellular iron deficiency as identifier of poor outcome

Elevated lactate in acute heart failure patients with intracellular iron deficiency as identifier of poor outcome

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

Persistent hyperlactataemia is related to high rates of in-hospital adverse events and poor outcome in acute heart failure

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