Decreasing body temperature predicts early rehospitalization in congestive heart failure
Decreasing body temperature predicts early rehospitalization in congestive heart failure
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DOI：
10.1016/j.cardfail.2008.02.008
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发表时间：
2008-08-01
影响因子：
6
通讯作者：
Casscells, S. Ward
中科院分区：
文献类型：
--
作者：
Ahmed, Amany;Aboshady, Ibrahim;Casscells, S. Ward
背景：充血性心力衰竭(CHF)。入院时体温低预示着住院死亡率。我们假设，出院后体温下降预示着CHF早期再住院和死亡。方法：我们回顾了198名CHF住院患者的出院记录。我们根据出院时的体温将患者分为低温或常温(截止温度为36.3摄氏度/97.4华氏度)。根据出院后至首次随访的体温变化方向分为常温/非降温(N+)组、常温/降温(N-)组、低温/非降温(H+)组、低温/降温(H-)组。结果：93例(47%)患者体温下降，105例(53%)患者体温未下降。Kaplan-Meier分析显示组间生存率(P=.01)和再住院时间(P=.005)有显著差异。Logistic回归分析显示，体温下降与180天内再住院显著相关(优势比为4.01；95%可信区间为1.63-10.02；P=0.003)。经Cox回归分析，N-、H+和H-组与N+组相比，死亡风险比分别为3.19(P=0.07)、6.49(P=0.004)和5.17(P=0.07)。在再住院时间方面，N-、H+和H-组与N+组相比，风险比分别为7.02(P=.01)、4.24(P=.08)和13.43(P=.005)。再次住院的时间减少，(结合体温过低)降低了存活率。
Background: In congestive heart failure (CHF). a low body temperature at hospital admission predicts in-hospital mortality. We hypothesized that a postdischarge reduction in body temperature predicts early CHF rehospitalization and death.Methods: We reviewed the records of 198 patients discharged after CHF hospitalization. We categorized the patients as hypothermic or normothermic (cutoff point, 36.3 degrees C/97.4 degrees F) according to body temperature at discharge. We classified the 2 groups according to the direction of temperature change between discharge e and the first follow-up visit: normothermic/non-decreasing temperature (N+), normothermic/ decreasing temperature (N-), hypothermic/non-decreasing temperature (H+), and hypothermic/decreasing temperature (H-).Results: Ninety-three patients (47%) had decreasing temperatures, and 105 patients (53%) had non-decreasing temperatures. Kaplan-Meier analysis revealed a significant intergroup difference in survival (P=.01) and rehospitalization time (P =.005). On logistic regression, a decreasing temperature was significantly associated with rehospitalization within 180 days (odds ratio, 4.01; 95% confidence interval, 1.63-10.02; P =.003). On Cox regression, the hazard ratios for death were 3.19 (P =.07) 6.49 (P =.004), and 5.17 (P =.07), for the N-, H+, and H- groups, respectively, versus the N+ group. For rehospitalization time, the hazard ratios were 7.02 (P = .01), 4.24 (P = .08), and 13.43 (P = .005) for the N-, H+, and H- groups, respectively, versus the N+ group.Conclusion: Decreasing body temperatures can predict readmission. decreased time to rehospitalization, and (in combination with hypothermia) decreased survival.