A new scoring system for predicting short‐term outcomes in Chinese patients with critically‐ill acute decompensated heart failure

Mo, Ran; Yu, Litian; Tan, Huiqiong; Wang, Yang; Yang, Yanmin; Liang, Yan; Zhu, Jun

doi:10.1186/s12872-021-02041-2

Cited by 2 publications

(1 citation statement)

References 34 publications

(37 reference statements)

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“…Patients in our study (group 2b) were treated only if NT-proBNP values or clinical signs were above reference values, indicating impending decompensation. Several measures were used as prognostic information for impending decompensation, such as the scoring system [ 23 ], body weight, and measurement of pulmonary ingestion by bioimpedance measurements [ 24 ]. In our cohort, plasma NT-proBNP levels were significantly elevated before levosimendan treatment and were decreased after levosimendan treatment.…”

Section: Discussionmentioning

confidence: 99%

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Wechsler

Schwinger

2022

Drugs - Real World Outcomes

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Background There is evidence that repetitive administration of levosimendan can improve outcome in chronic heart failure patients. Objective The aim of this retrospective study was to investigate the effect of therapy with levosimendan (LEV) additional to standard medical care in patients with symptomatic heart failure (HFrEF = heart failure with reduced ejection fraction) on NYHA class, NT-proBNP values, ejection fraction (EF) and body weight. Patients and Methods 178 participating patients (125 male, 53 female; mean age of 73 ± 13 years) were grouped according to whether LEV was given once (group 1) or repetitively (group 2). In group 2 data were analysed for first treatment with LEV (group 2a) and for the following repetitive LEV treatments (group 2b). The differentiation was required to see if there were different results for the particular groups. Results Repetitive dosing was given between two and 11 times, leading to 47 repetitive applications of LEV and a total of 225 (178 once + 47 repetitive) applications. The mean time between the repetitive dosing was 133 days or 4.3 months. LEV in addition to standard medical treatment was associated with reduction of NT-proBNP levels from 9138 to 7051 pg/mL ( p < 0.05). The corresponding values in group 2a and group 2b were 8790–4717 pg/mL ( p < 0.05) as well as 13,681–7581 pg/mL ( p < 0.05). The ejection fraction measured by echocardiography improved from 30 to 38% in group 1, from 31 to 45% in group 2a and from 30 to 35% in group 2b ( p < 0.05). Addition of LEV was associated with significant reduction of NYHA class and bodyweight in all groups. No adverse side effects (e.g., rhythm disorder, hypotension, electrolyte disorder) were seen. Conclusion LEV may be useful as an additive to standard care of treatment for patients with acute de novo decompensation due to acute heart failure as well as to prevent further deterioration in patients with chronic heart failure disease at high risk for hospitalisation. Intraindividual changes in NT-proBNP levels may be useful in decision-making about the need for additional treatment options in patients with worsening heart failure.

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Section: Discussionmentioning

confidence: 99%

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Wechsler

Schwinger

2022

Drugs - Real World Outcomes

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Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China

Zhao

Gao²,

Liu³

et al. 2022

BMC Cardiovasc Disord

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Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.

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A new scoring system for predicting short‐term outcomes in Chinese patients with critically‐ill acute decompensated heart failure

Cited by 2 publications

References 34 publications

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China

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