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Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure

BACKGROUND: Patients with acute heart failure (AHF) show various clinical courses during hospitalization. We aimed to identify time course predictors of in-hospital mortality and to establish a sequentially assessable risk model. METHODS AND RESULTS: We enrolled 1,035 consecutive AHF patients into d...

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Autores principales: Yagyu, Takeshi, Kumada, Masahiro, Nakagawa, Tsutomu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667756/
https://www.ncbi.nlm.nih.gov/pubmed/29095900
http://dx.doi.org/10.1371/journal.pone.0187410
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author Yagyu, Takeshi
Kumada, Masahiro
Nakagawa, Tsutomu
author_facet Yagyu, Takeshi
Kumada, Masahiro
Nakagawa, Tsutomu
author_sort Yagyu, Takeshi
collection PubMed
description BACKGROUND: Patients with acute heart failure (AHF) show various clinical courses during hospitalization. We aimed to identify time course predictors of in-hospital mortality and to establish a sequentially assessable risk model. METHODS AND RESULTS: We enrolled 1,035 consecutive AHF patients into derivation (n = 597) and validation (n = 438) cohorts. For risk assessments at admission, we utilized Get With the Guidelines-Heart Failure (GWTG-HF) risk scores. We examined significant predictors of in-hospital mortality from 11 variables obtained during hospitalization and developed a risk stratification model using multiple logistic regression analysis. Across both cohorts, 86 patients (8.3%) died during hospitalization. Using backward stepwise selection, we identified five time-course predictors: catecholamine administration, minimum platelet concentration, maximum blood urea nitrogen, total bilirubin, and C-reactive protein levels; and established a time course risk score that could sequentially assess a patient's risk status. The addition of a time course risk score improved the discriminative ability of the GWTG-HF risk score (c-statistics in derivation and validation cohorts: 0.776 to 0.888 [p = 0.002] and 0.806 to 0.902 [p<0.001], respectively). A calibration plot revealed a good relationship between observed and predicted in-hospital mortalities in both cohorts (Hosmer-Lemeshow chi-square statistics: 6.049 [p = 0.642] and 5.993 [p = 0.648], respectively). In each group of initial low-intermediate risk (GWTG-HF risk score <47) and initial high risk (GWTG-HF risk score ≥47), in-hospital mortality was about 6- to 9-fold higher in the high time course risk score group than in the low-intermediate time course risk score group (initial low-intermediate risk group: 20.3% versus 2.2% [p<0.001], initial high risk group: 57.6% versus 8.5% [p<0.001]). CONCLUSIONS: A time course assessment related to in-hospital mortality during the hospitalization of AHF patients can clearly categorize a patient's on-going status, and may assist patients and clinicians in deciding treatment options.
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spelling pubmed-56677562017-11-17 Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure Yagyu, Takeshi Kumada, Masahiro Nakagawa, Tsutomu PLoS One Research Article BACKGROUND: Patients with acute heart failure (AHF) show various clinical courses during hospitalization. We aimed to identify time course predictors of in-hospital mortality and to establish a sequentially assessable risk model. METHODS AND RESULTS: We enrolled 1,035 consecutive AHF patients into derivation (n = 597) and validation (n = 438) cohorts. For risk assessments at admission, we utilized Get With the Guidelines-Heart Failure (GWTG-HF) risk scores. We examined significant predictors of in-hospital mortality from 11 variables obtained during hospitalization and developed a risk stratification model using multiple logistic regression analysis. Across both cohorts, 86 patients (8.3%) died during hospitalization. Using backward stepwise selection, we identified five time-course predictors: catecholamine administration, minimum platelet concentration, maximum blood urea nitrogen, total bilirubin, and C-reactive protein levels; and established a time course risk score that could sequentially assess a patient's risk status. The addition of a time course risk score improved the discriminative ability of the GWTG-HF risk score (c-statistics in derivation and validation cohorts: 0.776 to 0.888 [p = 0.002] and 0.806 to 0.902 [p<0.001], respectively). A calibration plot revealed a good relationship between observed and predicted in-hospital mortalities in both cohorts (Hosmer-Lemeshow chi-square statistics: 6.049 [p = 0.642] and 5.993 [p = 0.648], respectively). In each group of initial low-intermediate risk (GWTG-HF risk score <47) and initial high risk (GWTG-HF risk score ≥47), in-hospital mortality was about 6- to 9-fold higher in the high time course risk score group than in the low-intermediate time course risk score group (initial low-intermediate risk group: 20.3% versus 2.2% [p<0.001], initial high risk group: 57.6% versus 8.5% [p<0.001]). CONCLUSIONS: A time course assessment related to in-hospital mortality during the hospitalization of AHF patients can clearly categorize a patient's on-going status, and may assist patients and clinicians in deciding treatment options. Public Library of Science 2017-11-02 /pmc/articles/PMC5667756/ /pubmed/29095900 http://dx.doi.org/10.1371/journal.pone.0187410 Text en © 2017 Yagyu et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Yagyu, Takeshi
Kumada, Masahiro
Nakagawa, Tsutomu
Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
title Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
title_full Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
title_fullStr Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
title_full_unstemmed Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
title_short Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
title_sort novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667756/
https://www.ncbi.nlm.nih.gov/pubmed/29095900
http://dx.doi.org/10.1371/journal.pone.0187410
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