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Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure

Year 2025, Volume: 15 Issue: 2, 162 - 168, 15.06.2025
https://doi.org/10.16919/bozoktip.1632218

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
https://doi.org/10.16919/bozoktip.1632218

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.
There are 28 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Research
Authors

Adem Köksal 0000-0001-8451-7397

İbrahim Çaltekin 0000-0002-3973-0655

Mehmet Seyfettin Sarıbaş 0000-0002-2037-0522

Mesut Tomakin 0000-0002-7767-2177

Ali Aygun 0000-0002-5190-1445

Publication Date June 15, 2025
Submission Date February 3, 2025
Acceptance Date April 14, 2025
Published in Issue Year 2025 Volume: 15 Issue: 2

Cite

APA Köksal, A., Çaltekin, İ., Sarıbaş, M. S., Tomakin, M., et al. (2025). Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure. Bozok Tıp Dergisi, 15(2), 162-168. https://doi.org/10.16919/bozoktip.1632218
AMA Köksal A, Çaltekin İ, Sarıbaş MS, Tomakin M, Aygun A. Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure. Bozok Tıp Dergisi. June 2025;15(2):162-168. doi:10.16919/bozoktip.1632218
Chicago Köksal, Adem, İbrahim Çaltekin, Mehmet Seyfettin Sarıbaş, Mesut Tomakin, and Ali Aygun. “Identification of Prognostic Markers in Patients With Acute Decompensated Heart Failure”. Bozok Tıp Dergisi 15, no. 2 (June 2025): 162-68. https://doi.org/10.16919/bozoktip.1632218.
EndNote Köksal A, Çaltekin İ, Sarıbaş MS, Tomakin M, Aygun A (June 1, 2025) Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure. Bozok Tıp Dergisi 15 2 162–168.
IEEE A. Köksal, İ. Çaltekin, M. S. Sarıbaş, M. Tomakin, and A. Aygun, “Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure”, Bozok Tıp Dergisi, vol. 15, no. 2, pp. 162–168, 2025, doi: 10.16919/bozoktip.1632218.
ISNAD Köksal, Adem et al. “Identification of Prognostic Markers in Patients With Acute Decompensated Heart Failure”. Bozok Tıp Dergisi 15/2 (June 2025), 162-168. https://doi.org/10.16919/bozoktip.1632218.
JAMA Köksal A, Çaltekin İ, Sarıbaş MS, Tomakin M, Aygun A. Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure. Bozok Tıp Dergisi. 2025;15:162–168.
MLA Köksal, Adem et al. “Identification of Prognostic Markers in Patients With Acute Decompensated Heart Failure”. Bozok Tıp Dergisi, vol. 15, no. 2, 2025, pp. 162-8, doi:10.16919/bozoktip.1632218.
Vancouver Köksal A, Çaltekin İ, Sarıbaş MS, Tomakin M, Aygun A. Identification of Prognostic Markers in Patients with Acute Decompensated Heart Failure. Bozok Tıp Dergisi. 2025;15(2):162-8.
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