Clinical research
Prognostic factors of mid-term clinical outcome in congestive heart failure patients discharged after acute decompensation
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Submission date: 2011-03-17
Final revision date: 2011-09-26
Acceptance date: 2011-12-05
Online publication date: 2012-07-04
Publication date: 2012-06-30
Arch Med Sci 2012;8(3):462–470
Introduction: Risk stratification in congestive heart failure (CHF) patients is based on a variety of clinical and laboratory variables. We analysed renal function, BNP, water composition, echocardiographic and functional determinations in predicting mid-term outcome in CHF patients discharged after decompensation.
Material and methods: All subjects with NYHA class II-IV were enrolled at hospital discharge. NYHA class, BNP, water body composition, non-invasive cardiac output and echocardiogram were analysed. Death, cardiac transplantation and hospital readmission for CHF were scheduled.
Results: Two-hundred and thirty-seven (64.5% males, age 71.1 ±10.1) patients were discharged after obtaining normal hydration; left ventricular ejection fraction (LVEF) was 43.2 ±16.2%, cardiac output was 3.8 ±1.1 l/min and BNP at discharge resulted 401.3 ±501.7 pg/ml. During the 14-month follow-up 15 patients (6.3%) died, 1 (0.4%) underwent cardiac transplantation and 18 (7.6%) were readmitted for CHF (event group); in 203 (85.6%) no events were observed (no-event group). Higher NYHA class (2.1 ±0.7 vs. 1.9 ±0.4, p = 0.01), BNP at discharge (750.2 ±527.3 pg/ml vs. 340.7 ±474.3 pg/ml, p = 0.002) and impaired LVEF (33.7 ±15.7% vs. 44.5 ±15.8%, p = 0.0001) and creatinine (1.7 ±0.6 vs. 1.2 ±0.8 mg/dl, p = 0.004) were noticed in the event group. At multivariate Cox analysis LVEF
(p = 0.0009), plasma creatinine (p = 0.006) and BNP at discharge (p = 0.001) were associated with adverse mid-term outcome. Kaplan-Meier survival curves demonstrated that adding cut-off points for creatinine 1.5 mg/dl and discharged BNP of 250 pg/ml discriminated significantly prognosis (p = 0.0001; log rank 21.09).
Conclusions: In predicting mid-term clinical prognosis in CHF patients discharged after acute decompensation, BNP at discharge  250 pg/ml added with plasma creatinine > 1.5 mg/dl are strong adverse predictors.