Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry
Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry
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DOI：
10.2459/jcm.0000000000000030
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发表时间：
2015-05-01
影响因子：
3
通讯作者：
Gheorghiade, Mihai
中科院分区：
文献类型：
--
作者：
Chioncel, Ovidiu;Ambrosy, Andrew P.;Gheorghiade, Mihai
AimThe本研究的目的是描述的流行病学，基线临床特征，在医院的管理，并直接或转移到ICU.Methods和resultsThe罗马尼亚急性心力衰竭综合征（RO-AHFS）登记处前瞻性地招募了3224名连续的患者在2008年1月和2009年5月之间入院的主要诊断为心力衰竭。受试者按ICU入院状态（即ICU+/ICU-）分类。采用多变量logistic回归分析确定ICU入院和住院死亡率的独立临床预测因素。总体而言，10.7%的患者需要ICU级别的护理，32%的患者直接进入ICU，68%的患者在住院期间转入ICU。入住ICU的患者平均年龄为68.111.3岁，61%为男性，67%有缺血性原因，44%出现新发心力衰竭。ICU+患者更常出现低SBP和脉压以及肾功能异常。32.7%的ICU+患者需要机械通气，56.7%的ICU+患者接受静脉正性肌力药物治疗。ICU+患者的院内死亡率高于ICU-患者（17.3% vs. 6.5%）。直接进入ICU的患者死亡率为15.3%，而入院后转移的患者死亡率为18.4%。年龄，血清钠，收缩压低于110 mmHg，左心室射血分数小于45%的预测ICU入院，而ICU+患者，年龄，血管加压药和机械通气的利用率是预测mortality.ConclusionsPatients入院直接或转移到ICU是在医院死亡率的高风险。通常在入院时测量的临床变量可能有助于处置决策，包括早期分诊到ICU。
AimThe present study aims to describe the epidemiology, baseline clinical characteristics, in-hospital management, and outcome of patients hospitalized for heart failure admitted directly or transferred to the ICU.Methods and resultsThe Romanian Acute Heart Failure Syndromes (RO-AHFS) registry prospectively enrolled 3224 consecutive patients between January 2008 and May 2009 admitted with a primary diagnosis of heart failure. Participants were classified by ICU admission status (i.e. ICU+/ICU-). Independent clinical predictors of ICU admission and in-hospital mortality were identified using multivariable logistic regression analysis. Overall, 10.7% of patients required ICU level care, 32% as a direct ICU admission, with 68% as an ICU transfer during hospitalization. Patients admitted to the ICU had a mean age of 68.111.3 years, 61% were men, 67% had an ischemic cause, and 44% presented with de-novo heart failure. ICU+ patients more frequently presented with low SBP and pulse pressure and abnormal renal function. Mechanical ventilation was required in 32.7% and intravenous inotropes were administered to 56.7% of ICU+ patients. ICU+ patients had higher in-hospital mortality compared to ICU- patients (17.3 vs. 6.5%). Patients admitted directly to the ICU had a 15.3% mortality rate compared to 18.4% in those transferred after admission. Age, serum sodium, SBP below 110 mmHg, and left-ventricular ejection fraction less than 45% were predictive of ICU admission, whereas for ICU+ patients, age, vasopressor, and mechanical ventilation utilization were predictive of mortality.ConclusionsPatients admitted directly or transferred to the ICU are at a high risk of in-hospital mortality. Clinical variables commonly measured at the time of admission may facilitate disposition decision-making including early triage to the ICU.