Hemodynamic support in acute decompensated heart failure: clinical and laboratory characteristics, predictors of unfavorable prognosis

Abstract

Introduction. Acute decompensation of chronic heart failure (ADCHF) is one of the leading causes of hospitalization in cardiac intensive care units (ICUs), associated with high mortality (up to 43% in the first year). The prognosis for patients requiring inotropic and/or vasopressor drugs is particularly unfavorable, creating a need to improve risk stratification methods.

Objective. To develop a model for predicting the need for inotropic and/or vasopressor therapy in patients with acute decompensation of chronic heart failure.

Methods. A prospective cohort study of 140 patients in the ICU. An analysis of clinicaldemographic, laboratory, and instrumental data was performed using multivariate logistic regression and ROC-analysis.

Results. A highly accurate model was created (AUROC 0.96), including three independent predictors: creatinine level >136.9 µmol/L (OR=22.32), alkaline phosphatase >120.1 U/L (OR=41.78), and the assessment of the HF phenotype. At a threshold of 9 points, the model’s sensitivity was 100%, specificity — 79%. Mortality in the group requiring support was significantly higher (32% vs.12.2%).

Conclusion. The model allows for accurate risk stratification of the need for inotropic/vasopressor drugs, which is especially important in emergency care settings and opens up opportunities for changing approaches to pharmacotherapy in patients with ADHF.