Predictors of 30-day mortality in patients admitted to ED for acute heart failure

Marchetti, Mirco; Benedetti, Antoine; Mimoz, Olivier; Lardeur, Jean-Yves; Guenezan, Jérémy; Marjanovic, Nicolas

doi:10.1016/j.ajem.2016.11.050

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Once a patient is admitted to hospital, a prognosis can be estimated using an additionally available early laboratory testing index, which appears to carry more predictive power. Marchetti et al [16] showed that the N-terminal pro b-type natriuretic peptide level with age and creatinine clearance on admission were predictors of 30-day mortality in adult patients with acute heart failure. Kong and Kang et al found that a high delta neutrophil index value is a useful marker to predict 28-day mortality in patients with acute pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department

Xiao-jun

Liu

et al. 2019

Medicine

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This study aimed to evaluate the performance of the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), and the modified early warning score (MEWS) in predicting the outcomes of adult patients presenting to the emergency department (ED). A retrospective review was undertaken between February 2014 and February 2018 in an adult ED of a 3300-bed university hospital. The RAPS, REMS, and MEWS were calculated to assess their capability to predict hospital admission, length of hospital stay, and in-hospital mortality, using area under receiver operating characteristic analysis. Multivariate analysis was used to identify variables that were independent predictors of the outcomes. We included 39,977 patients who had presented to the ED during 48 consecutive months, of whom 4857 were admitted and 213 died in hospital. The predictabilities of REMS, RAPS, and MEWS for hospital admission were 0.76, 0.59, and 0.55, respectively; the predictability of REMS, RAPS, and MEWS for hospital mortality were 0.88, 0.72, and 0.73, respectively; and the predictability of REMS, RAPS, and MEWS for length of hospital stay were 0.76, 0.67, and 0.65, respectively. Multivariate analysis showed that the Glasgow coma scale (GCS) (odds ratio (OR), 1.61; P < .001), age (OR, 1.50; P < .001), and MAP (OR, 1.27; P < .001) were independent predictors for hospital admission; GCS (OR, 2.92; P < .001), respiratory rate (RR) (OR, 2.69; P < .001), peripheral oxygen saturation (OR, 2.67; P < .001), MAP (OR, 2.11; P < .001), age (OR, 1.75; P < .001), and pulse rate (PR) (OR, 1.73; P < .001) were independent predictors for in-hospital mortality; and RR (OR, 1.41; P < .001), temperature (OR, 1.05; P = .01), and PR (OR, 0.96; P = .04) were independent predictors for length of hospital stay. Our study evaluated and confirmed the REMS as a powerful predictor of ED adult patient outcomes, including hospital admission, length of hospital stay, and in-hospital mortality compared to RAPS and MEWS.

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Section: Discussionmentioning

confidence: 99%

Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department

Xiao-jun

Liu

et al. 2019

Medicine

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“…AHF is a condition with poor prognosis, and the 30-day and 6-month mortality rate of AHF is approximately 20% and 30%, respectively [22, 23]. An accurate and rapid identification of AHF patients at high mortality risk is extremely important for facilitating clinical management of AHF patients and increasing overall survival [2].…”

Section: Discussionmentioning

confidence: 99%

Serum Irisin Predicts Mortality Risk in Acute Heart Failure Patients

Shen

Gao

Bei

et al. 2017

Cell Physiol Biochem

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Background/Aims: Irisin is a peptide hormone cleaved from a plasma membrane protein fibronectin type III domain containing protein 5 (FNDC5). Emerging studies have indicated association between serum irisin and many major chronic diseases including cardiovascular diseases. However, the role of serum irisin as a predictor for mortality risk in acute heart failure (AHF) patients is not clear. Methods: AHF patients were enrolled and serum was collected at the admission and all patients were followed up for 1 year. Enzyme-linked immunosorbent assay was used to measure serum irisin levels. To explore predictors for AHF mortality, the univariate and multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used. To determine the role of serum irisin levels in predicting survival, Kaplan-Meier survival analysis was used. Results: In this study, 161 AHF patients were enrolled and serum irisin level was found to be significantly higher in patients deceased in 1-year follow-up. The univariate logistic regression analysis identified 18 variables associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 2 variables namely blood urea nitrogen and serum irisin. ROC curve analysis indicated that blood urea nitrogen and the most commonly used biomarker, NT-pro-BNP, displayed poor prognostic value for AHF (AUCs ≤ 0.700) compared to serum irisin (AUC = 0.753). Kaplan-Meier survival analysis demonstrated that AHF patients with higher serum irisin had significantly higher mortality (P<0.001). Conclusion: Collectively, our study identified serum irisin as a predictive biomarker for 1-year all-cause mortality in AHF patients though large multicenter studies are highly needed.

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“…Outcomes for patients diagnosed with HF were poor in northern Tanzania, with a 30-day mortality rate of 25%, similar to recent studies from elsewhere in SSA [ 17 , 18 , 32 ]. The mortality rates observed in SSA are much higher than what has been reported outside of SSA [ 33 – 35 ]: in the United States, for example, the 30-day mortality rate following ED presentation for HF is between 4 and 12 percent [ 36 ]. The higher mortality rate in Tanzania might be partly due to the low uptake of recommended HF therapies both before and following the ED visit.…”

Section: Discussionmentioning

confidence: 99%

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

et al. 2021

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Background The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. Methods In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. Results Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21–0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35–5.56, p = 0.006). Conclusion In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.

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Predictors of 30-day mortality in patients admitted to ED for acute heart failure

Cited by 5 publications

References 31 publications

Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department

Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department

Serum Irisin Predicts Mortality Risk in Acute Heart Failure Patients

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

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