Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure
Year 2025,
Volume: 15 Issue: 2, 162 - 168, 15.06.2025
Adem Köksal
,
İbrahim Çaltekin
,
Mehmet Seyfettin Sarıbaş
,
Mesut Tomakin
,
Ali Aygun
Abstract
Purpose: This study aims to evaluate the effectiveness of prognostic markers in predicting 90-day mortality in patients admitted to the hospital with a diagnosis of acute decompensated heart failure (ADHF).
Materials and Methods: This retrospective study analyzed data from 559 ADHF patients admitted between 01.05.2023 and 01.09.2024. Age, sex, laboratory parameters, and 90-day mortality data were collected, and independent variables affecting mortality were evaluated via logistic regression and receiver operating characteristic (ROC) analysis.
Results: Age, blood urea nitrogen, albumin, and lactate levels were identified as independent predictors of 90-day mortality. The blood urea nitrogen level demonstrated the highest area under the curve (AUC = 0.673) for a cutoff value of 30.9 mg/dL. A significant increase in mortality risk was observed for patients with lactate levels >1.45 mmol/L.
Conclusion: Age, blood urea nitrogen, albumin, and lactate levels are strong prognostic markers for 90-day mortality in patients with ADHF. These findings may contribute to early risk stratification and the development of personalized treatment strategies.
References
- 1. Chao P, Cui X, Wang S, Zhang L, Ma Q, Zhang X. Serum albumin and
the short-term mortality in individuals with congestive heart failure in
intensive care unit: an analysis of MIMIC. Sci Rep. 2022;12(1):16251.
- 2. Rademaker MT, Pilbrow AP, Ellmers LJ, Palmer SC, Davidson
T, Mbikou P, et al. Acute Decompensated Heart Failure and the
Kidney: Physiological, Histological and Transcriptomic Responses to
Development and Recovery. J Am Heart Assoc. 2021;10(18):e021312.
- 3. Kahyaoğlu M, Karaduman A, Geçmen Ç, Candan Ö, Güner A,
Çakmak EÖ, et al. Serum lactate level may predict the development
of acute kidney injury in acute decompensated heart failure. Turk
Kardiyol Dern Ars. 2020;48(7):683-9.
- 4. Schmitt A, Schupp T, Reinhardt M, Abel N, Lau F, Forner J, et al.
Prognostic impact of acute decompensated heart failure in patients
with heart failure with mildly reduced ejection fraction. Eur Heart J
Acute Cardiovasc Care. 2024;13(2):225–41.
- 5. Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, et al. Validation
and derivation of short-term prognostic risk score in acute
decompensated heart failure in China. BMC Cardiovasc Disord.
2022;22(1):307.
- 6. Duan S, Li Y, Yang P. Predictive value of blood urea nitrogen in heart
failure: A systematic review and meta-analysis. Front Cardiovasc
Med. 2023;10:1189884.
- 7. Guo W, Zhao L, Zhao H, Zeng F, Peng C, Guo W, et al. The value of
lactate/albumin ratio for predicting the clinical outcomes of critically
ill patients with heart failure. Ann Transl Med. 2021;9(2):118
- 8. Spinar J, Jarkovsky J, Spinarova L, Mebazaa A, Gayat E, Vitovec J, et
al. AHEAD score—Long-term risk classification in acute heart failure.
Int J Cardiol. 2016;202:21–6.
- 9. Kasahara S, Sakata Y, Nochioka K, Tay WT, Claggett BL, Abe R,
et al. The 3A3B score: The simple risk score for heart failure with
preserved ejection fraction-A report from the CHART-2 Study. Int J
Cardiol. 2019;284:42-49.
- 10. Liu L, Feng L, Lu C, Zhang J, Zhao Y, Che L. A new nomogram to
predict in-hospital mortality in patients with acute decompensated
chronic heart failure and diabetes after 48 Hours of Intensive Care
Unit. BMC Cardiovasc Disord. 2024;24(1):199
- 11. Natella PA, Le Corvoisier P, Paillaud E, Renaud B, Mahé I,
Bergmann JF, et al. Long-term mortality in older patients discharged
after acute decompensated heart failure: a prospective cohort study.
BMC Geriatr. 2017;17(1):34
- 12. Le Corvoisier P, Bastuji-Garin S, Renaud B, Mahé I, Bergmann JF,
Perchet H, et al. Functional status and co-morbidities are associated
with in-hospital mortality among older patients with acute
decompensated heart failure: a multicentre prospective cohort
study. Age Ageing. 2014;44(2):225–31.
- 13. Carraro S, Veronese N, De Rui M, Manzato E, Sergi G. Acute
decompensated heart failure: Decision pathways for older people.
Eur Geriatr Med. 2015;6(5):456–61.
- 14. Lombardi C, Peveri G, Cani D, Latta F, Bonelli A, Tomasoni D, et al.
In‐hospital and long‐term mortality for acute heart failure: analysis
at the time of admission to the emergency department. ESC Heart
Fail. 2020;7(5):2650–61.
- 15. Jacob J, Miró Ò, Herrero P, Martín-Sánchez FJ, Gil V, Tost J, et al.
Predicting short-term mortality in patients with acute exacerbation
of chronic heart failure: The EAHFE-3D scale. Med Intensiva.
2016;40(6):348–55.
- 16. Ren X, Qu W, Zhang L, Liu M, Gao X, Gao Y, et al. Role of
blood urea nitrogen in predicting the post-discharge prognosis in
elderly patients with acute decompensated heart failure. Sci Rep.
2018;8(1):13507.
- 17. Cauthen CA, Lipinski MJ, Abbate A, Appleton D, Nusca A, Varma
A, et al. Relation of blood urea nitrogen to long-term mortality in
patients with heart failure. Am J Cardiol. 2008;101(11):1643–7.
- 18. Jujo K, Minami Y, Haruki S, Matsue Y, Shimazaki K, Kadowaki H,
et al. Persistent high blood urea nitrogen level is associated with
increased risk of cardiovascular events in patients with acute heart
failure. ESC Heart Fail. 2017;4(4):545–53.
- 19. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC.
ADHERE Scientific Advisory Committee and Investigators. Clinical
presentation, management, and in-hospital outcomes of patients
admitted with acute decompensated heart failure with preserved
systolic function: a report from the Acute Decompensated Heart
Failure National Registry (ADHERE) Database. J Am Coll Cardiol.
2006;47(1):76–84.
- 20. Ouyang J, Wang H, Huang J. The role of lactate in cardiovascular
diseases. Cell Commun Signal. 2023;21(1):317
- 21. Biegus J, Zymliński R, Sokolski M, Jankowska EA, Banasiak W,
Ponikowski P. Elevated lactate in acute heart failure patients with
intracellular iron deficiency as identifier of poor outcome. Kardiol
Pol. 2019;77(3):347–54.
- 22. Zymliński R, Biegus J, Sokolski M, Siwołowski P, Nawrocka‐
Millward S, Todd J, et al. Increased blood lactate is prevalent and
identifies poor prognosis in patients with acute heart failure
without overt peripheral hypoperfusion. European J of Heart Fail.
2018;20(6):1011–8.
- 23. Uyar H, Yesil E, Karadeniz M, Orscelik O, Ozkan B, Ozcan T, et al.
The effect of high lactate level on mortality in acute heart failure
patients with reduced ejection fraction without cardiogenic shock.
Cardiovasc Toxicol. 2020;20(4):361-9
- 24. Kawase T, Toyofuku M, Higashihara T, Okubo Y, Takahashi L,
Kagawa Y, et al. Validation of lactate level as a predictor of early
mortality in acute decompensated heart failure patients who
entered intensive care unit. J Cardiol. 2015;65(2):164–70.
- 25. Uthamalingam S, Kandala J, Daley M, Patvardhan E, Capodilupo
R, Moore SA, et al. Serum albumin and mortality in acutely
decompensated heart failure. Am Heart J. 2010;160(6):1149–55.
- 26. Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, et al.
Association of an increase in serum albumin levels with positive
1-year outcomes in acute decompensated heart failure: A cohort
study. PLoS One. 2020;15(12):e0243818.
- 27. Karki S, Gajjar R, Bittar-Carlini G, Jha V, Yadav N. Association of
hypoalbuminemia with clinical outcomes in patients admitted with
acute heart failure. Curr Probl Cardiol. 2023;48(11):101916.
- 28. Bonilla-Palomas JL, Gámez-López AL, Moreno-Conde M,
López-Ibáñez MC, Anguita-Sánchez M, de la Sacristana ÁG, et
al. Hypoalbuminemia in acute heart failure patients: causes
and its impact on hospital and long-term mortality. J Card Fail.
2014;20(5):350–8.
Akut Dekompanse Kalp Yetersizliği Olan Hastalarda Prognostik Belirteçlerin Tanımlanması
Year 2025,
Volume: 15 Issue: 2, 162 - 168, 15.06.2025
Adem Köksal
,
İbrahim Çaltekin
,
Mehmet Seyfettin Sarıbaş
,
Mesut Tomakin
,
Ali Aygun
Abstract
Amaç: Bu çalışmada akut dekompanse kalp yetmezliği (ADKY) tanısıyla hastaneye yatırılan hastalarda 90 günlük mortaliteyi öngörmede prognostik belirteçlerin etkinliği değerlendirildi.
Gereç ve Yöntemler: Bu retrospektif çalışmada 01.05.2023 ile 01.09.2024 tarihleri arasında hastaneye yatırılan 559 ADHF hastasının verileri analiz edildi. Yaş, cinsiyet, laboratuvar parametreleri ve 90 günlük mortalite verileri toplandı ve mortaliteyi etkileyen bağımsız değişkenler lojistik regresyon ve alıcı işletim karakteristiği (ROC) analizi ile değerlendirildi.
Bulgular: Yaş, kan üre azotu, albümin ve laktat düzeyleri 90 günlük mortalitenin bağımsız belirleyicileri olarak tanımlandı. Kan üre nitrojen düzeyi, 30.9 mg/dL kesme değeri için en yüksek eğri altında kalan alanı (AUC = 0.673) göstermiştir. Laktat düzeyi >1,45 mmol/L olan hastalarda mortalite riskinde anlamlı bir artış gözlenmiştir.
Sonuçlar: Yaş, kan üre azotu, albümin ve laktat düzeyleri ADHF hastalarında 90 günlük mortalite için güçlü prognostik belirteçlerdir. Bu bulgular erken risk tabakalandırmasına ve kişiselleştirilmiş tedavi stratejilerinin geliştirilmesine katkıda bulunabilir.
References
- 1. Chao P, Cui X, Wang S, Zhang L, Ma Q, Zhang X. Serum albumin and
the short-term mortality in individuals with congestive heart failure in
intensive care unit: an analysis of MIMIC. Sci Rep. 2022;12(1):16251.
- 2. Rademaker MT, Pilbrow AP, Ellmers LJ, Palmer SC, Davidson
T, Mbikou P, et al. Acute Decompensated Heart Failure and the
Kidney: Physiological, Histological and Transcriptomic Responses to
Development and Recovery. J Am Heart Assoc. 2021;10(18):e021312.
- 3. Kahyaoğlu M, Karaduman A, Geçmen Ç, Candan Ö, Güner A,
Çakmak EÖ, et al. Serum lactate level may predict the development
of acute kidney injury in acute decompensated heart failure. Turk
Kardiyol Dern Ars. 2020;48(7):683-9.
- 4. Schmitt A, Schupp T, Reinhardt M, Abel N, Lau F, Forner J, et al.
Prognostic impact of acute decompensated heart failure in patients
with heart failure with mildly reduced ejection fraction. Eur Heart J
Acute Cardiovasc Care. 2024;13(2):225–41.
- 5. Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, et al. Validation
and derivation of short-term prognostic risk score in acute
decompensated heart failure in China. BMC Cardiovasc Disord.
2022;22(1):307.
- 6. Duan S, Li Y, Yang P. Predictive value of blood urea nitrogen in heart
failure: A systematic review and meta-analysis. Front Cardiovasc
Med. 2023;10:1189884.
- 7. Guo W, Zhao L, Zhao H, Zeng F, Peng C, Guo W, et al. The value of
lactate/albumin ratio for predicting the clinical outcomes of critically
ill patients with heart failure. Ann Transl Med. 2021;9(2):118
- 8. Spinar J, Jarkovsky J, Spinarova L, Mebazaa A, Gayat E, Vitovec J, et
al. AHEAD score—Long-term risk classification in acute heart failure.
Int J Cardiol. 2016;202:21–6.
- 9. Kasahara S, Sakata Y, Nochioka K, Tay WT, Claggett BL, Abe R,
et al. The 3A3B score: The simple risk score for heart failure with
preserved ejection fraction-A report from the CHART-2 Study. Int J
Cardiol. 2019;284:42-49.
- 10. Liu L, Feng L, Lu C, Zhang J, Zhao Y, Che L. A new nomogram to
predict in-hospital mortality in patients with acute decompensated
chronic heart failure and diabetes after 48 Hours of Intensive Care
Unit. BMC Cardiovasc Disord. 2024;24(1):199
- 11. Natella PA, Le Corvoisier P, Paillaud E, Renaud B, Mahé I,
Bergmann JF, et al. Long-term mortality in older patients discharged
after acute decompensated heart failure: a prospective cohort study.
BMC Geriatr. 2017;17(1):34
- 12. Le Corvoisier P, Bastuji-Garin S, Renaud B, Mahé I, Bergmann JF,
Perchet H, et al. Functional status and co-morbidities are associated
with in-hospital mortality among older patients with acute
decompensated heart failure: a multicentre prospective cohort
study. Age Ageing. 2014;44(2):225–31.
- 13. Carraro S, Veronese N, De Rui M, Manzato E, Sergi G. Acute
decompensated heart failure: Decision pathways for older people.
Eur Geriatr Med. 2015;6(5):456–61.
- 14. Lombardi C, Peveri G, Cani D, Latta F, Bonelli A, Tomasoni D, et al.
In‐hospital and long‐term mortality for acute heart failure: analysis
at the time of admission to the emergency department. ESC Heart
Fail. 2020;7(5):2650–61.
- 15. Jacob J, Miró Ò, Herrero P, Martín-Sánchez FJ, Gil V, Tost J, et al.
Predicting short-term mortality in patients with acute exacerbation
of chronic heart failure: The EAHFE-3D scale. Med Intensiva.
2016;40(6):348–55.
- 16. Ren X, Qu W, Zhang L, Liu M, Gao X, Gao Y, et al. Role of
blood urea nitrogen in predicting the post-discharge prognosis in
elderly patients with acute decompensated heart failure. Sci Rep.
2018;8(1):13507.
- 17. Cauthen CA, Lipinski MJ, Abbate A, Appleton D, Nusca A, Varma
A, et al. Relation of blood urea nitrogen to long-term mortality in
patients with heart failure. Am J Cardiol. 2008;101(11):1643–7.
- 18. Jujo K, Minami Y, Haruki S, Matsue Y, Shimazaki K, Kadowaki H,
et al. Persistent high blood urea nitrogen level is associated with
increased risk of cardiovascular events in patients with acute heart
failure. ESC Heart Fail. 2017;4(4):545–53.
- 19. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC.
ADHERE Scientific Advisory Committee and Investigators. Clinical
presentation, management, and in-hospital outcomes of patients
admitted with acute decompensated heart failure with preserved
systolic function: a report from the Acute Decompensated Heart
Failure National Registry (ADHERE) Database. J Am Coll Cardiol.
2006;47(1):76–84.
- 20. Ouyang J, Wang H, Huang J. The role of lactate in cardiovascular
diseases. Cell Commun Signal. 2023;21(1):317
- 21. Biegus J, Zymliński R, Sokolski M, Jankowska EA, Banasiak W,
Ponikowski P. Elevated lactate in acute heart failure patients with
intracellular iron deficiency as identifier of poor outcome. Kardiol
Pol. 2019;77(3):347–54.
- 22. Zymliński R, Biegus J, Sokolski M, Siwołowski P, Nawrocka‐
Millward S, Todd J, et al. Increased blood lactate is prevalent and
identifies poor prognosis in patients with acute heart failure
without overt peripheral hypoperfusion. European J of Heart Fail.
2018;20(6):1011–8.
- 23. Uyar H, Yesil E, Karadeniz M, Orscelik O, Ozkan B, Ozcan T, et al.
The effect of high lactate level on mortality in acute heart failure
patients with reduced ejection fraction without cardiogenic shock.
Cardiovasc Toxicol. 2020;20(4):361-9
- 24. Kawase T, Toyofuku M, Higashihara T, Okubo Y, Takahashi L,
Kagawa Y, et al. Validation of lactate level as a predictor of early
mortality in acute decompensated heart failure patients who
entered intensive care unit. J Cardiol. 2015;65(2):164–70.
- 25. Uthamalingam S, Kandala J, Daley M, Patvardhan E, Capodilupo
R, Moore SA, et al. Serum albumin and mortality in acutely
decompensated heart failure. Am Heart J. 2010;160(6):1149–55.
- 26. Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, et al.
Association of an increase in serum albumin levels with positive
1-year outcomes in acute decompensated heart failure: A cohort
study. PLoS One. 2020;15(12):e0243818.
- 27. Karki S, Gajjar R, Bittar-Carlini G, Jha V, Yadav N. Association of
hypoalbuminemia with clinical outcomes in patients admitted with
acute heart failure. Curr Probl Cardiol. 2023;48(11):101916.
- 28. Bonilla-Palomas JL, Gámez-López AL, Moreno-Conde M,
López-Ibáñez MC, Anguita-Sánchez M, de la Sacristana ÁG, et
al. Hypoalbuminemia in acute heart failure patients: causes
and its impact on hospital and long-term mortality. J Card Fail.
2014;20(5):350–8.