Clinical characteristics and logistic regression analysis of risk factors for short-term prognosis in elderly patients with acute decompensated heart failure / 中华老年医学杂志

ABSTRACT

Objective To investigate the clinical characteristics and the associated risk factors for short-term prognosis in elderly patients with acute decompensated heart failure, in order to provide the evidence for improving clinical survival.Methods Clinical data of 200 elderly patients with acute decompensated heart failure in our hospital from June 2010 to December 2014 were retrospectively analyzed.The associated risk factors for prognosis were analyzed by using multivariate logistic regression analysis.All patients were followed up for six months, and cardiovascular events during the same follow-up period were recorded.All patients were divided into non-event group (n=158, no readmission during the follow-up period) and event group (n=42, readmission or death during follow-up).Results All the 200 elderly patients with acute decompensated heart failure had completed the 6 months follow-up, 23 (11.5％) patients died from cardiovascular events, and 19 (9.5％) patients had readmission due to heart failure.New York Heart Association (NYHA) classification, age, heart rate, systolic blood pressure, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic dimension (LVEDD) had significant differences between the two groups (x2=5.791, t=2.514, 2.552, 2.500, 2.582, 3.870, 2.275, all P＜0.05).Levels of NT-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity C reactive protein (hs-CRP), red cell distribution width (RDW), creatinine, and uric acid were higher in the event group than in the non-event group (t=54.948, 9.932, 2.815, 8.888, 2.368, all P＜0.05).The hemoglobin level was lower in the event group than in the non-event group (t-2.455, P＜0.05).Multivariate unconditional logistic regression analysis showed that NYHA classification, LVEF, and NT-proBNP were the independent risk factors for the prognosis of acute decompensated heart failure in elderly patients (x2 =10.438, 61.943, 6.976, all P＜0.05).The mortality rate was 11.5％ within the six months follow-up.The area under the receiver operating characteristic (ROC) curve for NT-proBNP to predict short-term mortality was 0.860 (SE=0.034,P=0.000, 95％ CI 0.794-0.926).The mortality within 6 months was lower in NT-proBNP ≤205 ng/L group than in NT proBNP＞ 205 ng / L group (x2=5.385, P=0.020).Conclusions NYHA classification, LVEF, and NT proBNP are the risk factors for the prognosis of acutely decompensated heart failure in the elderly.The elderly patients with acute decompensated heart failure have a poor prognosis.