The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

Abstract

Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age > 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (>2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (>28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (>21 mg/dl, HR = 1.75), albumin (<3.5 g/dl, HR = 2.02), troponin T (TnT) (>0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (>5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p < 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

Predictive value of blood urea nitrogen in heart failure: a systematic review and meta-analysis

“…Among the remaining 4,979 papers, a series of publications unrelated to heart failure research, such as conference studies and case reports, were excluded, and 131 articles were obtained. A re-screening of data types and outcome indicators of blood urine nitrogen was performed on the 131 articles, and 19 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) of them were finally included (Figure 1).…”

Saudi Heart Association Position Statement on the Use of Biomarkers for the Management of Heart Failure and Acute Coronary Syndrome

“…BNP and NT-proBNP have similar prognostic value in chronic HF on the level of mortality (all-cause, cardiovascular, HF mortality) [ 64 ] and HF-related hospitalization [ 65 ]. Serum troponin T levels can also serve for the early prediction of short-term outcomes such as 28-day mortality in acute HF [ 66 ]. In the context of chronic HF, hs-cTnT strongly predicts mortality (all-cause and cardiovascular), in addition to cardiovascular-related hospitalization [ 67 , 68 ].…”

Construction of a web‐based dynamic nomogram for predicting the prognosis in acute heart failure

“…Some studies reported that demographic information (age), clinical manifestations (NYHA functional class, SBP, DBP, and MAP), pre‐existing conditions (diabetes mellitus and AF), medications (vasopressors), laboratory tests (NT‐proBNP, haemoglobin, sodium, albumin, creatinine, blood urea nitrogen, and eGFR), and 12‐lead resting ECG (RBBB) were significantly associated with OS 8,9,37–40 . However, in the other studies, there was no apparent association of demographic information (age), clinical manifestations (SBP and DBP), pre‐existing conditions (AF), medications, and laboratory tests (NT‐proBNP, haemoglobin, sodium, and creatinine) with long‐term survival 41–43 . To our knowledge, this study is the first risk stratification model to consider including VHD, CRT, and indicators of SPECT MPI (i.e.…”

“…8,9,37-40 However, in the other studies, there was no apparent association of demographic information (age), clinical manifestations (SBP and DBP), pre-existing conditions (AF), medications, and laboratory tests (NT-proBNP, haemoglobin, sodium, and creatinine) with long-term survival. [41][42][43] To our knowledge, this study is the first risk stratification model to consider including VHD, CRT, and indicators of SPECT MPI (i.e. rest scar burden) to predict the prognosis of AHF.…”