Predictors of Postdischarge Outcomes From Information Acquired Shortly After Admission for Acute Heart Failure A Report From the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study
Predictors of Postdischarge Outcomes From Information Acquired Shortly After Admission for Acute Heart Failure A Report From the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study
复制标题
DOI：
10.1161/circheartfailure.113.000284
复制
发表时间：
2014-01-01
影响因子：
9.7
通讯作者：
O'Connor, Christopher M.
中科院分区：
文献类型：
--
作者：
Cleland, John G.;Chiswell, Karen;O'Connor, Christopher M.
背景急性心力衰竭是入院的常见原因，预后往往较差。改善预后风险分层可能有助于未来试验的设计和患者管理。从一个大的随机试验的数据，我们探讨了临床变量的预后价值，在入院急性心力衰竭，以确定是否有几个选定的变量是劣于一个扩展dataset.Methods和结果的预后模型包括37个临床特征收集在基线的RECT，研究比较罗茶碱和安慰剂在2033例急性心力衰竭患者入院。30天时预先规定的结局为死亡或因任何原因再次住院;因心血管或肾脏原因死亡或再次住院;以及30天和180天时的全因死亡率。没有变量的c指数>0.70，也很少有变量的c指数>0.60;复合结局的c指数低于死亡率。血尿素通常是最强的单一预测因子。18个变量提供了独立的预后信息，但仅使用8个项目（年龄、既往心力衰竭住院、外周水肿、收缩压、血清钠、尿素、肌酐和白蛋白）的简化模型表现相似。对于预测180 d全因死亡率，使用所有变量的模型c指数为0.72，简化模型c指数也为0.72。结论急性心力衰竭患者入院时测量的一些简单临床变量预测各种不良结局的准确性与更复杂的模型相似。然而，预测模型的准确性只有中等，特别是对于包括非致命性事件的结局。需要更好的风险分层方法。临床试验注册URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00328692和NCT 00354458。
Background Acute heart failure is a common reason for admission, and outcome is often poor. Improved prognostic risk stratification may assist in the design of future trials and in patient management. Using data from a large randomized trial, we explored the prognostic value of clinical variables, measured at hospital admission for acute heart failure, to determine whether a few selected variables were inferior to an extended data set.Methods and Results The prognostic model included 37 clinical characteristics collected at baseline in PROTECT, a study comparing rolofylline and placebo in 2033 patients admitted with acute heart failure. Prespecified outcomes at 30 days were death or rehospitalization for any reason; death or rehospitalization for cardiovascular or renal reasons; and, at both 30 and 180 days, all-cause mortality. No variable had a c-index >0.70, and few had values >0.60; c-indices were lower for composite outcomes than for mortality. Blood urea was generally the strongest single predictor. Eighteen variables contributed independent prognostic information, but a reduced model using only 8 items (age, previous heart failure hospitalization, peripheral edema, systolic blood pressure, serum sodium, urea, creatinine, and albumin) performed similarly. For prediction of all-cause mortality at 180 days, the model c-index using all variables was 0.72 and for the simplified model, also 0.72.Conclusions A few simple clinical variables measured on admission in patients with acute heart failure predict a variety of adverse outcomes with accuracy similar to more complex models. However, predictive models were of only moderate accuracy, especially for outcomes that included nonfatal events. Better methods of risk stratification are required.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.