Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort

Tahar Chouihed, Aurélien Buessler, Adrien Bassand, Deborah Jaeger, Jean Marc Virion, Lionel Nace, Françoise Barbé, Sylvain Salignac, Patrick Rossignol, Faiez Zannad, Nicolas Girerd, Tahar Chouihed, Aurélien Buessler, Adrien Bassand, Deborah Jaeger, Jean Marc Virion, Lionel Nace, Françoise Barbé, Sylvain Salignac, Patrick Rossignol, Faiez Zannad, Nicolas Girerd

Abstract

Objectives: To assess the prognostic value of hyponatraemia, hyperglycaemia and impaired estimated glomerular filtration rate (eGFR) in predicting in-hospital death in patients with acute heart failure (AHF) admitted for acute dyspnoea in the emergency department.

Design: Retrospective observational study.

Setting: Emergency Department of the University Hospital of Nancy. Data were collected from August 2013 to October 2015.

Participants: The analysis included 405 patients with AHF admitted for acute dyspnoea in an emergency department.

Results: The population was elderly (mean age 82 years), 20.1% had hyponatraemia, 45.1% had hyperglycaemia and 48.6% had eGFR <50 mL/min/1.73 m2. Sixty-one patients (15.1%) died in hospital, mostly due to cardiac aetiology (58.3%). In multivariable analysis adjusted for key potential confounders, adjusted hyponatraemia (OR=2.40, (1.16 to 4.98), p=0.02), hyperglycaemia (OR=2.00, 1.06 to 3.76, p=0.03) and eGFR <50 mL/min/1.73 m2 (OR=1.97 (1.00 to 3.80), p=0.04*) were all identified as significant independent predictors of in-hospital death.

Conclusions: Results of basic routine laboratory tests (hyponatraemia, hyperglycaemia and impaired eGFR) performed on admission in the emergency department are independently associated with in-hospital death. These inexpensive tests, performed as early as patient admission in the emergency department, could allow the early identification of patients admitted for AHF who are at high risk of in-hospital death.

Trial registration number: NCT02800122.

Keywords: acute heart failure; basic laboratory test parameters; emergency department; mortality predictors.

Conflict of interest statement

Competing interests: TC and NG have received Board Membership Fees from Novartis. PR received fees from Relypsa. FZ has received fees for serving on the board of Boston Scientific; consulting fees from Novartis, Takeda, AstraZeneca, Boehringer Ingelheim, GE Healthcare, Relypsa, Servier, Boston Scientific, Bayer, Johnson and Johnson, and Resmed; and speakers’ fees from Pfizer and AstraZeneca. FZ and PR are co-founders of CardioRenal diagnostics.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Flow chart. AHF, acute heart failure.

References

    1. Prekker ME, Feemster LC, Hough CL, et al. . The epidemiology and outcome of prehospital respiratory distress. Acad Emerg Med 2014;21:543–50. 10.1111/acem.12380
    1. Kelly AM, Holdgate A, Keijzers G, et al. . Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study. Scand J Trauma Resusc Emerg Med 2016;24:113–9. 10.1186/s13049-016-0305-5
    1. Chouihed T, Manzo-Silberman S, Peschanski N, et al. . Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey. Scand J Trauma Resusc Emerg Med 2016;24:112–8. 10.1186/s13049-016-0300-x
    1. Ray P, Birolleau S, Lefort Y, et al. . Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care 2006;10:R82 10.1186/cc4926
    1. Zannad F, Mebazaa A, Juillière Y, et al. . Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006;8:697–705. 10.1016/j.ejheart.2006.01.001
    1. Frigerio M, Mazzali C, Paganoni AM, et al. . Trends in heart failure hospitalizations, patient characteristics, in-hospital and 1-year mortality: A population study, from 2000 to 2012 in Lombardy. Int J Cardiol 2017;236:310–4. 10.1016/j.ijcard.2017.02.052
    1. Harjola P, Boyd J, Tarvasmäki T, et al. . The impact of emergency medical services in acute heart failure. Int J Cardiol 2017;232:222–6. 10.1016/j.ijcard.2017.01.017
    1. Omar HR, Guglin M. Community acquired versus hospital acquired hyponatremia in acute heart failure: Association with clinical characteristics and outcomes. Int J Cardiol 2016;225:247–9. 10.1016/j.ijcard.2016.09.135
    1. Targher G, Dauriz M, Tavazzi L, et al. . on behalf of IN-HF Outcom Investigators. Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry. International Journal of Cardiology 2016;206:587–93.
    1. Weidmann ZM, Breidthardt T, Twerenbold R, et al. . Prediction of mortality using quantification of renal function in acute heart failure. Int J Cardiol 2015;201:650–7. 10.1016/j.ijcard.2015.08.097
    1. Farmakis D, Filippatos G, Parissis J, et al. . Hyponatremia in heart failure. Heart Fail Rev 2009;14:59–63. 10.1007/s10741-008-9109-7
    1. Mebazaa A, Gayat E, Lassus J, et al. . Association between elevated blood glucose and outcome in acute heart failure: results from an international observational cohort. J Am Coll Cardiol 2013;61:820–9. 10.1016/j.jacc.2012.11.054
    1. Coiro S, Rossignol P, Ambrosio G, et al. . Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure: Prognostic value of B-lines after discharge from HF hospitalisation. European Journal of Heart Failure 2015;17:1172–81.
    1. Saepudin S, Ball PA, Morrissey H. Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure. BMC Cardiovasc Disord 2015;15:88 10.1186/s12872-015-0082-5
    1. Radulović B, Potočnjak I, Dokoza Terešak S, et al. . Hypochloraemia as a predictor of developing hyponatraemia and poor outcome in acute heart failure patients. Int J Cardiol 2016;212:237–41. 10.1016/j.ijcard.2016.03.081
    1. Park JJ, Cho YJ, Oh IY, et al. . Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction: An analysis of the Korean Acute Heart Failure registry. Int J Cardiol 2017;248:239–45. 10.1016/j.ijcard.2017.08.004
    1. Jao GT, Chiong JR. Hyponatremia in acute decompensated heart failure: mechanisms, prognosis, and treatment options. Clin Cardiol 2010;33:666–71. 10.1002/clc.20822
    1. Gheorghiade M, Abraham WT, Albert NM, et al. . Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007;28:980–8. 10.1093/eurheartj/ehl542
    1. Damman K, Testani JM. The kidney in heart failure: an update. Eur Heart J 2015;36:1437–44. 10.1093/eurheartj/ehv010
    1. Ruggenenti P, Remuzzi G. Worsening kidney function in decompensated heart failure: treat the heart, don’t mind the kidney. Eur Heart J 2011;32:2476–8. 10.1093/eurheartj/ehr242
    1. Breidthardt T, Weidmann ZM, Twerenbold R, et al. . Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function: Haemoconcentration during acute heart failure therapy. European Journal of Heart Failure 2017;19:226–36.
    1. Berra G, Garin N, Stirnemann J, et al. . Outcome in acute heart failure: prognostic value of acute kidney injury and worsening renal function. J Card Fail 2015;21:382–90. 10.1016/j.cardfail.2014.12.015
    1. Kataja A, Tarvasmäki T, Lassus J, et al. . The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock - Results from the CardShock Study. Int J Cardiol 2017;226:48–52. 10.1016/j.ijcard.2016.10.033
    1. Sud M, Wang X, Austin PC, et al. . Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes. Eur Heart J 2015;36:924–31. 10.1093/eurheartj/ehu462
    1. Kattel S, Kasai T, Matsumoto H, et al. . Association between elevated blood glucose level on admission and long-term mortality in patients with acute decompensated heart failure. J Cardiol 2017;69:619–24. 10.1016/j.jjcc.2016.05.013
    1. Lee DS, Stitt A, Austin PC, et al. . Prediction of heart failure mortality in emergent care: a cohort study. Ann Intern Med 2012;156:767–75. 10.7326/0003-4819-156-11-201206050-00003
    1. Danchin N, Puymirat E, Steg PG, et al. . Five-year survival in patients with ST-segment-elevation myocardial infarction according to modalities of reperfusion therapy: the French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 Cohort. Circulation 2014;129:1629–36. 10.1161/CIRCULATIONAHA.113.005874
    1. Logeart D, Thabut G, Jourdain P, et al. . Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol 2004;43:635–41. 10.1016/j.jacc.2003.09.044
    1. Fonarow GC, Peacock WF, Phillips CO, et al. . ADHERE Scientific Advisory Committee and Investigators. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol 2007;49:1943–50.
    1. Pascual-Figal DA, Casas T, Ordonez-Llanos J, et al. . Highly sensitive troponin T for risk stratification of acutely destabilized heart failure. Am Heart J 2012;163:1002–10. 10.1016/j.ahj.2012.03.015
    1. Walker AS, Mason A, Quan TP, et al. . Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records. Lancet 2017;390:62–72. 10.1016/S0140-6736(17)30782-1
    1. Passantino A, Monitillo F, Iacoviello M, et al. . Predicting mortality in patients with acute heart failure: Role of risk scores. World J Cardiol 2015;7:902–11. 10.4330/wjc.v7.i12.902

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever