Development and Validation of a Simple-to-Use Nomogram for Predicting In-Hospital Mortality in Patients With Acute Heart Failure Undergoing Continuous Renal Replacement Therapy

Abstract

Background: Patients with acute heart failure (AHF) who require continuous renal replacement therapy (CRRT) have a high risk of in-hospital mortality. It is clinically important to screen high-risk patients using a model or scoring system. This study aimed to develop and validate a simple-to-use nomogram consisting of independent prognostic variables for the prediction of in-hospital mortality in patients with AHF undergoing CRRT.Methods: We collected clinical data for 121 patients with a diagnosis of AHF who underwent CRRT in an AHF unit between September 2011 and August 2020 and from 105 patients in the medical information mart for intensive care III (MIMIC-III) database. The nomogram model was created using a visual processing logistic regression model and verified using the standard method.Results: Patient age, days after admission, lactic acid level, blood glucose concentration, and diastolic blood pressure were the significant prognostic factors in the logistic regression analyses and were included in our model (named D-GLAD) as predictors. The resulting model containing the above-mentioned five factors had good discrimination ability in both the training group (C-index, 0.829) and the validation group (C-index, 0.740). The calibration and clinical effectiveness showed the nomogram to be accurate for the prediction of in-hospital mortality in both the training and validation cohort when compared with other models. The in-hospital mortality rates in the low-risk, moderate-risk, and high-risk groups were 14.46, 40.74, and 71.91%, respectively.Conclusion: The nomogram allowed the optimal prediction of in-hospital mortality in adults with AHF undergoing CRRT. Using this simple-to-use model, the in-hospital mortality risk can be determined for an individual patient and could be useful for the early identification of high-risk patients. An online version of the D-GLAD model can be accessed at https://ahfcrrt-d-glad.shinyapps.io/DynNomapp/.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT0751838.

Continuous Renal Replacement Therapy for Hypertension Complicated by Refractory Heart Failure: An Analysis of Safety and Nursing Highlights

“…In this study, we observed better therapeutic effects in RHF patients treated with CRRT, with significantly improved CF after treatment and shorter time of asthma relief, HRR, and hospitalization, confirming the excellent application effect of CRRT on RHF, which is consistent with the results of previous studies [ 22 , 23 ]. Compared with routine hemodialysis treatment, CRRT can more effectively remove fluid and stabilize hemodynamics while regulating fluid balance through continuous and slow blood purification, with no obvious impact on the cardiovascular system [ 24 ].…”

Development and validation of a prognostic nomogram for gastrointestinal stromal tumors in the postimatinib era: A study based on the SEER database and a Chinese cohort

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Clinical outcomes of severe sepsis and septic shock patients with left ventricular dysfunction undergoing continuous renal replacement therapy

“…The treatment goals for acute heart failure (AHF) in the ICU are to improve organ perfusion and hemodynamic stability, alleviate symptoms, and limit cardiac and renal injury 10 , which can be achieved by CRRT. The CRRT mimics urine output by continuously and slowly removing the plasma water and achieving accurate volume control and hemodynamic stability 9 , 11 . The 2016 European Society of Cardiology guidelines recommended the consideration of RRT in patients with AHF with refractory volume overload and AKI 10 .…”