Abstract
IntroductionSeveral blood tests are performed uniformly in patients hospitalized with acute decompensated heart failure and are predictive of the outcomes: complete blood count, electrolytes, renal function, glucose, albumin and uric acid. We sought to evaluate the relationship between routine admission laboratory tests results, patient characteristics and 30-day and one-year mortality of patients admitted for decompensated heart failure and to construct a simple mortality prediction tool.MethodsA retrospective population based study. Data from seven tertiary hospitals on all admissions with a principal diagnosis of heart failure during the years 2002–2005 throughout Israel were captured.Results8,246 patients were included in the study cohort. Thirty day mortality rate was 8.5% (701 patients) and one-year mortality rate was 28.7% (2,365 patients). Addition of five routine laboratory tests results (albumin, sodium, blood urea, uric acid and WBC) to a set of clinical and demographic characteristics improved c-statistics from 0.76 to 0.81 for 30-days and from 0.72 to 0.76 for one-year mortality prediction (both p-values <0.0001). Three dichotomized abnormal laboratory results with highest odds ratio for one-year mortality (hypoalbuminaemia, hyponatremia and elevated blood urea) were used to construct a simple prediction score, capable of discriminating from 1.1% to 21.4% in 30-day and from 11.6% to 55.6% in one-year mortality rates between patients with a score of 0 (1,477 patients) vs. score of 3 (544 patients).DiscussionA small set of abnormal routine laboratory results upon admission can risk-stratify and independently predict 30-day and one-year mortality in patients hospitalized with acute decompensated heart failure.
Highlights
Several blood tests are performed uniformly in patients hospitalized with acute decompensated heart failure and are predictive of the outcomes: complete blood count, electrolytes, renal function, glucose, albumin and uric acid
Low albumin concentration can be an indicator of inflammation superimposed on cardiac cachexia – both factors associated with increased mortality in populations with Heart failure (HF).[13,14]
We found that the addition of readily available laboratory tests improve significantly the predictive ability of the survival models based on clinical and demographic characteristics
Summary
Several blood tests are performed uniformly in patients hospitalized with acute decompensated heart failure and are predictive of the outcomes: complete blood count, electrolytes, renal function, glucose, albumin and uric acid. Several blood tests are performed almost uniformly in patients hospitalized with acute, decompensated heart failure: a complete blood count, electrolytes levels, renal function, glucose, albumin and uric acid levels. Single measurement of the total white blood cells (WBC) count is associated with all-cause and cardiovascular mortality in clinically stable patients with left ventricular (LV) systolic dysfunction.[3,4] Renal impairment is a frequent prognosticator for mortality in patients hospitalized with HF.[5,6] Hyponatremia and hyperkalemia are common in patients admitted with heart failure and have been shown to predict mortality.[7,8,9,10] Uric acid (UA) levels can be a marker of impaired prognosis in hospitalized patients with acute HF and LV systolic dysfunction.[11,12] Low albumin concentration can be an indicator of inflammation superimposed on cardiac cachexia – both factors associated with increased mortality in populations with HF.[13,14] high blood glucose levels are associated with worsening of HF in diabetic and non-diabetic subjects.[15,16]
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