Predictors of in-hospital and long-term mortality in unselected patients admitted to a modern coronary care unit

Abstract

Aims Objective data on epidemiology, management and outcome of patients with acute cardiac illness are still scarce, and producing evidence-based guidelines remains an issue. In order to define the clinical characteristics and the potential predictors of in-hospital and long-term mortality, we performed a retrospective, observational study, in a tertiary cardiac centre in Italy. Methods One thousand one hundred and sixty-five consecutive patients, admitted to our intensive cardiac care unit (ICCU) during the year 2016, were included in the study. The data were collected from the hospital discharge summary and the electronic chart records. Results Global in-hospital mortality was 7.2%. Predictors of in-hospital mortality were age [odds ratio (OR): 2.0; P = 0.011], female sex (OR: 2.18; P = 0.003), cardiac arrest (OR: 12.21; P = 0.000), heart failure/cardiogenic shock (OR: 9.99; P = 0.000), sepsis/septic shock (OR: 5.54; P = 0.000), acute kidney injury (OR: 3.25; P = 0.021) and a primary diagnosis of acute heart failure or a condition other than acute heart failure and acute coronary syndrome. During a mean follow-up period of 17.4 ± 4.8 months, 96 all-cause deaths occurred in patients who were still alive at discharge. One-year mortality rate was 8.2%. Predictors of long-term mortality were age (hazard ratio: 1.08; P = 0.000), female sex (hazard ratio: 0.59; P = 0.022), comorbidity at least 3 (hazard ratio: 1,60; P = 0.047), acute kidney injury (hazard ratio: 3.15; P = 0.001), inotropic treatment (hazard ratio: 2.54; P = 0.002) and a primary diagnosis of acute heart failure. Conclusion In our Level-2 ICCU, predictors of in-hospital and long-term mortality are similar to those commonly found in a Level-3 ICU. These data strongly suggest that ICUs dealing with acute cardiovascular patients should be reorganized with a necessary upgrading of competences and resources for medical and nursing staff.

Renal failure after trans-catheter aortic valve implantation

“…Sgura et al pointed out the prognostic impact of acute kidney injury (AKI) on early mortality after balloon-expandable TAVI, especially in patients with severe chronic kidney disease (CKD) [3]. Both AKI and renal function during hospitalization had been reported as predictors of poor outcome in either TAVI or non-TAVI setting [4][5][6][7]. However, the authors need to be congratulated for dealing with an important issue about the management of patients undergoing an increasingly widespread treatment.…”

“…This implies better technologies and minimizing acute complications such as pacemaker implantation, vascular injury, renal failure and radiological exposure [1,2].Sgura et al pointed out the prognostic impact of acute kidney injury (AKI) on early mortality after balloon-expandable TAVI, especially in patients with severe chronic kidney disease (CKD) [3]. Both AKI and renal function during hospitalization had been reported as predictors of poor outcome in either TAVI or non-TAVI setting [4][5][6][7]. However, the authors need to be congratulated for dealing with an important issue about the management of patients undergoing an increasingly widespread treatment.We recently reported similar results in a larger multicentre population undergoing self-expanding TAVI with longer follow-up [8].…”

Incidence and outcomes of acute kidney injury stratified by cardiogenic shock severity

“…Acute kidney injury (AKI) is one of the most common manifestations of end‐organ dysfunction in critically ill patients 1,2 . The development of AKI portends a poor prognosis in patients with critical illness requiring intensive care unit (ICU) admission 2‐4 . AKI is common in patients presenting to the Cardiac Intensive Care Unit (CICU), and the co‐occurrence of acute cardiac dysfunction and AKI is termed acute cardiorenal syndrome (CRS) 3,5‐7 .…”

“…The development of AKI portends a poor prognosis in patients with critical illness requiring intensive care unit (ICU) admission 2‐4 . AKI is common in patients presenting to the Cardiac Intensive Care Unit (CICU), and the co‐occurrence of acute cardiac dysfunction and AKI is termed acute cardiorenal syndrome (CRS) 3,5‐7 . Clearance biomarkers reflecting kidney dysfunction (including AKI) have been integrated into multiple severity of illness scoring systems to predict morbidity and mortality in critically ill populations 3,5,8 .…”

“…AKI is common in patients presenting to the Cardiac Intensive Care Unit (CICU), and the co‐occurrence of acute cardiac dysfunction and AKI is termed acute cardiorenal syndrome (CRS) 3,5‐7 . Clearance biomarkers reflecting kidney dysfunction (including AKI) have been integrated into multiple severity of illness scoring systems to predict morbidity and mortality in critically ill populations 3,5,8 . Among patients presenting with cardiogenic shock (CS), kidney dysfunction and AKI (especially AKI requiring dialysis, AKI‐D) are prognostic markers that portend worse outocmes 5,9‐11 …”