Critical Care and Shock

Predictor of Mortality and Rehospitalization of Acute Decompensated Heart Failure at Six Months Follow Up


Objective. To look for predictors of mortality and rehospitalization, we conducted a prospective study using fifty variables from history, physical examination, ECG, CXR, Echocardiography and blood test (N Terminal proBNP, hsCRP, and lactate level) that suspected as predictors in heart failure

Design. Blinded prospective cohort study

Setting. Emergency room of Harapan Kita National Heart Center, Jakarta-Indonesia as entry site, with ICCU, wards, and OPD for evaluation.

Patients population for study. All consecutive patients with acute decompensated heart failure class III-IV that were hospitalized. Exclusion criteria were other concomitant severe diseases.

Measurements and result. Of 97 patients enrolled, variables were measured using standard protocols. During follow up period of six months, 11 (11.3%) patients died of cardiac origin and 29 (29.9%) rehospitalized. Logistic regression analysis revealed BMI >30 kg/m2 with edema had OR 6.6 (95% CI: 1.33- 32.72, p=0,021), acute lung edema had OR 3,65 (CI 0,99-13,35, p=0,037), NYHA class IV had OR 5,42 (CI 95% : 1,11-26,59, p=0,037), left ventricle wall thickness >11 mm had OR 0,79 (CI 95 %: 0,63-1,00, p= 0,05), using beta-blocker had OR 0,09 ( CI 95%: 0,01- 0,74, p= 0,025), hemoglobin <12 g/dL had OR 4,53 (CI 95%: 1,24-16,56, p= 0,022), sodium <130 mmol/dL had OR 3,78( CI 95%: 1,02-14,03,p=0,047), NT proBNP >17,860 pg/mL on admission had OR 9,02 (CI 95%: 2.30-35.30, p=0,02) or NT proBNP > 8,499 pg/dL at discharge had OR 13,2 (CI 95%: 1,32-132,01, p=0,028) and served as predictors of mortality respectively. Using Cox Proportional Hazards and Kaplan Meier survival analysis and log rank test it were found that NT proBNP level >17.860 pg/ml on admission had a HR of 7.15 (95%CI 2.08-24.56, p=002) for mortality, while NT proBNP level >8.499 at discharged showed a HR of 9.55 (95%CI 1.06-85.77, p=0.044) for mortality. A decrease >35% of NT proBNP had a HR 0.13 (95%CI 0.02-1.19, p=0.071) for mortality, 0.38 (95%CI 0.14-1.00, p=0.049) for rehospitalization, and 0.42 (95%CI 0.12-0.76, p=0.010) for both. NT proBNP on admission >17.860 pg/dL together with EF <20 %, BMI >30 kg/m2 with edema and NYHA class IV were the most accurate predictor with AUC =0,94 (p=0.0001).

Conclusion. Non decreased NT proBNP > 35 % during hospitalization was the predictor of mortality and rehospitalization. NT proBNP > 17,860 pg/mL at entry, NT proBNP > 8,499 pg/mL at discharged, NYHA class IV, BMI >30 kg/m2 with edema, EF <20%, acute pulmonary edema, Hb <12 g/dL, Na <130 mmol/ dL and not using beta-blocker were found as predictors for mortality of heart failure.