The Related Study On The Influencing Factors And The Prediction For The Adverse Short-term Prognosis In Acute Decompensated Heart Failure

Part One Association between tricuspid annular systolic velocity and adverse short-term prognosis in acute decompensated heart failureObjective:To explore the relationship between the tricuspid annular systolic velocity(one of the parameters for evaluating right ventricular systolic function)and adverse short-term prognosis in patients with acute decompensated heart failure(ADHF).Methods:A total of 732 ADHF patients hospitalized in the Cardiology of the Second Hospital of Hebei Medical University from February 2017 to December 2018 were divided into three groups according to the tertiles of S’.Demographic characteristics,comorbidities,physical examinations,lab tests,and medications were collected by trained medical staff.Univariable and Multivariable logistic regression models were utilized to gauge the relationship between S’and the risk of a composite of short-term all-cause mortality or 30-day heart failure(HF)-related rehospitalization.Results:The number of composite outcome events identified in the study population was 85,with the short-term all-cause death coupled with 30-day HF readmission events reaching 23 and 62,respectively.When S’was analysed as a categorical variable,as per the multivariable adjusted analysis,S’was inversely related to the risk of a composite outcome[<10 cm/s odds ratios(OR)2.90,95%confidence interval(CI):1.33-6.31;10-11 cm/s OR 2.18,95%CI:1.10-4.33;P for trend=0.006]in comparison with S’at>11 cm/s.When S’was analysed as a continuous variable,per 1 cm/s increase,the OR(95%CI)for a composite outcome was[0.87(0.77-0.99),P=0.028],which means S’was also inversely associated with the risk of a composite outcome.Conclusions:A more impaired tricuspid annular peak systolic velocity is associated with a poorer short-term prognosis of patients with ADHF.Part Two Associations between serum electrolyte and adverse short-term prognosis in acute decompensated heart failureObjective:To explore the relationship between the concentrations of different serum electrolytes coupled with the number of electrolyte abnor-malities and adverse short-term prognosis in patients with acute decompensated heart failure(ADHF).Methods:A total of 5166 ADHF patients hospitalized in the cardiology of the 13 tertiary hospitals in Hebei province from February 2017 to December 2018 were divided into four serum electrolyte-related study popula-tions[potassium(n=5145),sodium(n=5135),chloride(n=4966),serum total calcium(STC)(n=4143)]under corresponding exclusions.Univariable and Multivariable logistic regression models were utilized to gauge the relation-ship between electrolyte levels together with number of electrolyte abnor-malities and the risk of a composite of short-term all-cause mortality or 30-day heart failure(HF)-related rehospitalization.Results:In multivariable adjusted analysis,patients with potassium below 3.5 mmol/L[odds ratios(OR)1.45;95%confidence interval(CI):1.07-1.95],4.01-4.50 mmol/L(OR:1.29,CI:1.02-1.62),4.51-5.00 mmol/L(OR:1.43,CI:1.08-1.90),and above 5.00 mmol/L(OR:1.74,CI:1.21-2.51)had an increased risk of outcome when compared with potassium at 3.50-4.00 mmol/L.Sodium levels were inversely related to the risk of a composite outcome[<130 mmol/L:OR:2.73(95%CI,1.81-4.12);130-134 mmol/L:OR,1.97(CI,1.45-2.68);135-140mmol/L:OR,1.45(CI,1.17-1.81);P for trend<0.001]in comparison with sodium at 141-145 mmol/L.Chloride<95 mmol/L corres-ponded to a higher risk of a composite outcome with an OR of 1.65(95%CI,1.16-2.37)in contrast to chloride levels at 101-105 mmol/L.In addition,the adjusted ORs(95%CI)for a composite outcome comparing the STC<2.00and 2.00-2.24 vs 2.25-2.58 mmol/L were 0.98(0.69-1.43)and 1.13(0.89-1.44),respectively.Besides that,the number of electrolyte abnormalities was positively related to the risk of a composite outcome[N=1 OR 1.40,95%CI:1.13-1.73;N=2 OR 2.51,95%CI:1.85-3.42;N=3 OR 2.47,95%CI:1.45-4.19;P for trend<0.001]in comparison with N=0.Conclusions:A deviation of potassium levels from 3.50 to 4.00 mmol/L,lower sodium levels,chloride lower than 95mmol/L,and increased number of electrolyte abnormalities were associated with poorer short-term prognosis in ADHF.However,there is no association of a higher risk of adverse recent outcome with hypocalcaemia.Part Three Development and validation of a new comorbidity score to predict prognosis in acute decompensated heart failureObjective:To develop a new comorbidity score(NCS)to predict prognosis in acute decompensated heart failure(ADHF),which we compared with three existing scoring systems.Methods:A total of 4760 ADHF patients hospitalized in the cardiology of the 13 tertiary hospitals in Hebei province from February 2017 to December 2018 were divided into derivation(n=3200)and validation(n=1560)cohorts.Using multivariable logistic regression analysis to spot the predictors and develop the NCS.The discrimination of each scoring system was determined by the area under the receiver operating characteristic curve(AUROC).Besides,the Hosmer-Lemeshow goodness-of-fit test was imple-mented to evaluate the calibration of the new scoring system.Results:Using multivariable logistic regression analysis,the NCS was defined as-2×(first admission for heart failure)+3×(acute myocardial infarc-tion)-1×(hypertension)+2×(atrial fibrillation/atrial flutter)+1(stroke/transient ischemia attack)+2×(abnormal renal parameters)+1×(anemia)+2×(hypoalbu-minemia)+1×(potassium abnormality)+4×(hyponatremia),with an AUROC of0.652(95%confidence interval[CI]:0.622-0.683)for the derivation cohort,and good calibration(x~2=6.074,P=0.693).In addition,the distinguishing power was validated in the internal and external validation cohorts,with AUROC of 0.677(95%CI:0.632-0.722)and 0.692(95%CI:0.668-0.716),respectively,which represented the highest values of all the scoring systems.Additionally,the calibrations were all good(the Hosmer-Lemeshow test,all P>0.05).Conclusions:We developed a new comorbidity score that exhibited acceptable prognostic value and excellent calibration compared with the current three scoring systems,both in short-and long-term prognosis of patients with ADHF.When the score is>2 points,more refined treatment strategies should be considered to optimize outcomes.