Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort

Abstract

ObjectivesTo assess the prognostic value of hyponatraemia, hyperglycaemia and impaired estimated glomerular filtration rate (eGFR) in predicting in-hospital death in patients with acute heart failure (AHF) admitted for acute dyspnoea in the emergency department.DesignRetrospective observational study.SettingEmergency Department of the University Hospital of Nancy. Data were collected from August 2013 to October 2015.ParticipantsThe analysis included 405 patients with AHF admitted for acute dyspnoea in an emergency department.ResultsThe population was elderly (mean age 82 years), 20.1% had hyponatraemia, 45.1% had hyperglycaemia and 48.6% had eGFR <50 mL/min/1.73 m2. Sixty-one patients (15.1%) died in hospital, mostly due to cardiac aetiology (58.3%). In multivariable analysis adjusted for key potential confounders, adjusted hyponatraemia (OR=2.40, (1.16 to 4.98), p=0.02), hyperglycaemia (OR=2.00, 1.06 to 3.76, p=0.03) and eGFR <50 mL/min/1.73 m2 (OR=1.97 (1.00 to 3.80), p=0.04*) were all identified as significant independent predictors of in-hospital death.ConclusionsResults of basic routine laboratory tests (hyponatraemia, hyperglycaemia and impaired eGFR) performed on admission in the emergency department are independently associated with in-hospital death. These inexpensive tests, performed as early as patient admission in the emergency department, could allow the early identification of patients admitted for AHF who are at high risk of in-hospital death.Trial registration numberNCT02800122.

Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics

“…In the present study, irrespective of DM, admission HGL was a significant predictor of IHD in AHF, but DM was not a predictor of IHD. Several studies also have shown that HGL is an independent predictor of IHD in patients with AHF [13][14][15][16]. Sud et al also showed that mildly elevated presentation blood glucose is associated with 30-day mortality and hospitalization in AHF patients with no pre-existing DM [16].…”

Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the ED

“…Indeed, the Brest score efficiently rules out AHF diagnosis for scores < 4 and affirms the diagnosis for scores > 9. However, for patients with an intermediate score (4)(5)(6)(7)(8), other complementary tools (biomarkers and/or LUS) 9 seemingly appear necessary to improve diagnostic accuracy 19 .…”

“…Prognosis is related to initiation time of specific therapies 5 . In-hospital mortality is typically reported to be greater than 10% 6 and has remained stable in the last 30 years.…”

Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

“…This study is reported as per the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guideline ( S1 Checklist ). The Pathway of dyspneic patients in Emergency (PARADISE) cohort is a retrospective cohort study including consecutive patients aged 18 years or older who were admitted for acute dyspnea in the ED of the Nancy University Hospital (France) between January 1, 2015 and December 31, 2015 as detailed previously [ 21 , 22 ]. The hospital’s electronic charts (resurgences) were systematically reviewed by investigators to search for the records of all patients admitted for acute dyspnea in the ED.…”