Risk stratification after hospitalization for decompensated heart failure
Risk stratification after hospitalization for decompensated heart failure
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DOI：
10.1016/j.cardfail.2004.02.011
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发表时间：
2004-12-01
影响因子：
6
通讯作者：
O'Connor, CM
中科院分区：
文献类型：
--
作者：
Felker, GM;Leimberger, JD;O'Connor, CM
背景：失代偿性心力衰竭（HF）是美国最常见的住院指征之一，但对入院时预测不良事件的特征知之甚少。我们使用来自静脉注射米力农治疗慢性心力衰竭加重的前瞻性试验（OPTIME-CHF）研究的数据来建立一个预测失代偿心力衰竭患者结局的模型。方法和结果：OPTIME-CHF随机选择949例失代偿心力衰竭住院患者，给予米力农或安慰剂48至72小时。我们使用多变量建模来评估入院时的变量，这些变量可以预测60天死亡率或60天内死亡或再住院的综合情况。预测60天内死亡的变量包括年龄增加、收缩压降低、纽约心脏协会IV级症状、血尿素氮（BUN）升高和钠减少。60天内死亡或再住院的综合预测因子是前12个月内HF住院次数、BUN升高、收缩压降低、血红蛋白降低和经皮冠状动脉介入治疗（PCI）史。该模型对死亡率模型（c-index）具有显著的区分力。77)，但复合终点（c-index .69）较少。结论：失代偿性心衰患者的风险分层可以通过易于评估的临床变量来完成。进一步研究该模型在独立样本中的有效性将有助于制定风险分层策略。
Background: Decompensated heart failure (HF) is among the most common indications for hospitalization in the United States, but little is known about features on admission that predict adverse events. We used data from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study to develop a model that would predict outcomes in patients with decompensated HEMethods and Results: OPTIME-CHF randomized 949 patients hospitalized with decompensated HF for 48 to 72 hours of infusion of either milrinone or placebo. We used multivariable modeling to evaluate variables on admission that would be predictive of 60-day mortality or the composite of death or rehospitalization at 60 days. Variables at presentation that predicted death at 60 days were increased age, lower systolic blood pressure, New York Heart Association class IV symptoms, elevated blood urea nitrogen (BUN), and decreased sodium. Predictors of the composite of death or rehospitalization within 60 days were the number of HF hospitalizations in the preceding 12 months, elevated BUN, lower systolic blood pressure, decreased hemoglobin, and a history of percutaneous coronary intervention (PCI). The discriminatory power of the model was substantial for the mortality model (c-index .77) but less for the composite endpoint (c-index .69).Conclusions: Risk stratification of patients with decompensated HF may be accomplished using easily assessed clinical variables. Further research into the validity of this model in independent samples will potentially aid in the development of risk stratification strategies.