Assessment of risk factors for in-hospital mortality in patients with acute heart failure admitted to intensive care units

Introduction. Acute heart failure (AHF) is the leading cause of admission in intensive care units with a high incidence of deaths. The development of models for predicting the unfavourable course during the hospitalization period, regardless of the AHF phenotype, can significantly affect clinical decision-making algorithms and improve outcomes.
The purpose of the study. Determining the risk factors of in-hospital mortality for patients with acute renal failure and assessment of the possibility of constructing a multifactorial prognostic model.
Materials and methods. A pilot single-centre prospective cohort study was conducted, including 208 patients diagnosed with acute respiratory failure in the intensive care unit. Anamnestic, clinical, laboratory and instrumental data were evaluated. The Mann–Whitney test and the Fisher precision test were used to compare the groups. The odds ratio (OR) was evaluated with a 95% confidence interval. The threshold values of quantitative variables were determined by the Yuden criterion in the ROC analysis.
Results. Hospital mortality was 13.9%. In a one-dimensional analysis, risk factors for death included: age ≥76 years (p=0.017), coronary heart disease (p=0.008), chronic kidney disease (p=0.040), peripheral atherosclerosis (p=0.011), and a history of CABG (p=0.037). Laboratory parameters showed an increase in creatinine (p=0.006), urea (p<0.001), bilirubin (p=0.005), LDH (p<0.001), CRP (p=0.004), D-dimer (p=0.041), INR (p=0.006), as well as a decrease in GFR (p=0.003), albumin (p=0.049), total protein (p=0.012), cholesterol (p=0.017) and iron (p=0.027). Physical data and most instrumental parameters, with the exception of the presence of a hydrothorax (p=0.025), did not demonstrate prognostic significance. Multifactorial analysis proved impossible due to the clinical heterogeneity of the AHF phenotypes.
Conclusion. The study identified risk factors for in hospital mortality in acute renal failure. The construction of a multifactorial model turned out to be impossible due to the pronounced clinical incompatibility of different AHF phenotypes. The data obtained call into question the validity of considering AHF as a single nosological category and indicate the expediency of switching to phenotype-specific prediction of outcomes.

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