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 () (>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.
Highlights
Heart failure (HF) is one of the most frequent cardiovascularrelated diseases in modern society, which influences the growing number of populations around the world [1–3]
The training data with respect to clinical characteristics of patients with acute heart failure (AHF) were obtained from the Medical Information Mart for Intensive Care III (MIMIC III), derived from a large, freely accessible critical care database comprising deidentified health records (58,976 hospitalization records) of 46,520 patients who were admitted to the intensive care unit (ICU) of Beth Israel Deaconess Medical Center between June 2001 and October 2012
In our medical record system, we identified patients with AHF at first admission between January 2019 and April 2021 in the ICU, emergency ICU (EICU), and coronary care unit (CCU) (Figure 1)
Summary
Heart failure (HF) is one of the most frequent cardiovascularrelated diseases in modern society, which influences the growing number of populations around the world [1–3]. In contrast to the great improvements in the treatment of chronic heart failure (CHF), acute heart failure (AHF) is still associated with a worse prognosis, with 90-day readmission rates and 1 year mortality reaching 10–30% in the United States [2, 5]. Researchers from the different regions have made some attempts to discover the prognostic factors in predicting the short-term (28–30-days) or long-term (1–5 years) mortality and readmission in patients with AHF [7– 17]. Following the concept of “time-to-treatment,” early identifying patients with AHF at high risk of mortality at initial admission to the intensive care unit (ICU) could significantly help clinicians to achieve a timely diagnosis and individualized treatment modality. 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
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