Background
Methods
Study population
Data collection and endpoints
Statistical analysis
Results
Baseline characteristics
Variable | Value | Derivation cohort (n = 1014) | Validation cohort (n = 254) |
---|---|---|---|
Gender (men) | 873 (68.8%) | 709 (69.9%) | 164 (64.6%) |
Age (years) | 58 ± 17 | 58 ± 17 | 58 ± 17 |
Age ≥ 75 years | 227 (17.9%) | 179 (17.7%) | 48 (18.9%) |
Etiologies (n, %)
| |||
Ischemic heart disease | 385 (30.4) | 336 (33.1) | 49 (19.3) |
Valvular disease | 215 (17.0) | 161 (15.9) | 54 (21.3) |
Cardiomyopathy | 438 (34.5) | 330 (32.5) | 108 (42.6) |
Arrhythmias | 42 (3.3) | 39 (3.8) | 3 (1.2) |
Myocarditis and pericardial disease | 29 (2.3) | 23 (2.3) | 6 (2.5) |
Congenital heart disease | 62 (4.9) | 43 (4.2) | 19 (7.4) |
Aortic disease | 7 (0.6) | 6 (0.6) | 1 (0.4) |
Pulmonary heart disease | 33 (2.6) | 30 (3.0) | 3 (1.2) |
Infiltration and toxic damage | 56 (4.4) | 46 (4.5) | 10 (4.1) |
Cardiogenic shock (n,%) | 89 (7.0) | 62 (6.1) | 27 (10.6) |
NYHA IV (n,%) | 621 (49.0) | 466 (46.0) | 155 (61.0) |
BMI (kg/m2) | 23.90 ± 4.50 | 24.05 ± 4.50 | 23.56 ± 4.86 |
Glasgow coma scale | 14.8 ± 0.85 | 14.8 ± 0.86 | 14.7 ± 0.86 |
Temperature (℃) | 36.35 ± 0.42 | 36.33 ± 0.43 | 36.40 ± 0.38 |
SBP (mmHg) | 115.06 ± 20.46 | 115.86 ± 20.37 | 111.88 ± 20.49 |
HR (BPM) | 80 ± 19 | 80 ± 19 | 81 ± 21 |
RR (min−1) | 19 ± 3 | 19 ± 3 | 19 ± 3 |
Diabetes mellitus (%) | 342 (27.0) | 273 (26.9) | 69 (27.2) |
Smoking (%) | 632 (49.8) | 512 (50.5) | 120 (47.2) |
Alcohol use (%) | 509 (40.1) | 412 (40.6) | 97 (38.2) |
Arterial pH | 7.45 ± 0.11 | 7.44 ± 0.11 | 7.46 ± 0.05 |
PaO2 (mmHg) | 87.46 ± 26.79 | 88.01 ± 25.38 | 85.30 ± 31.65 |
AB (mmol/L) | 24.41 ± 4.40 | 24.44 ± 4.43 | 24.30 ± 4.33 |
Lactic acid (mmol/L) | 1.82 ± 1.15 | 1.83 ± 1.20 | 1.78 ± 1.03 |
Serum sodium (mmol/L) | 136.06 ± 5.05 | 136.35 ± 5.08 | 134.92 ± 4.76 |
Serum potassium (mmol/L) | 4.05 ± 0.58 | 4.06 ± 0.58 | 4.02 ± 0.60 |
Leukocyte count (× 109/L) | 7.8 ± 3.5 | 7.8 ± 3.5 | 8.0 ± 3.7 |
Hemoglobin (g/L) | 134.9 ± 24.7 | 135.8 ± 24.3 | 131.5 ± 25.8 |
Hematocrit | 0.409 ± 0.071 | 0.411 ± 0.070 | 0.398 ± 0.074 |
INR | 1.39 ± 0.89 | 1.37 ± 0.96 | 1.46 ± 0.58 |
D-dimer (mg/L) | 2.24 ± 3.49 | 2.21 ± 3.83 | 2.35 ± 2.92 |
Total bilirubin (μmol/L) | 29.5 ± 25.3 | 29.7 ± 24.0 | 28.5 ± 29.9 |
Uric acid (μmol/L) | 540.4 ± 196.3 | 532.1 ± 191.0 | 573.4 ± 213.3 |
Hs-TNI (μg/L) | 0.045 (0.02–0.10) | 0.04 (0.02–0.10) | 0.06 (0.02–0.13) |
NT-proBNP (ng/ml) | 5478.2 (2286.5–11,957.3) | 4966.5 (2171.3–10,728.9) | 6821.2 (3028.5–17,569.3) |
LVEF
| |||
HFrEF (yes, %) | 790 (62.3) | 629 (62.0) | 161 (63.4) |
HFmrEF (yes, %) | 176 (13.9) | 141 (13.9) | 35 (13.8) |
HFpEF (yes, %) | 302 (23.8) | 244 (24.1) | 58 (22.8) |
PASP > 30 mmHg (%) | 590 (46.5) | 456 (45.0) | 134 (52.8) |
eGFR (ml/min/1.73 m
2
)
| |||
eGFR ≥ 90 (%) | 271 (21.4) | 232 (22.9) | 39 (15.3) |
60 ≤ eGFR < 90 (%) | 375 (29.6) | 283 (27.9) | 92 (36.2) |
30 ≤ eGFR < 60 (%) | 489 (38.6) | 383 (37.8) | 106 (41.7) |
15 ≤ eGFR < 30 (%) | 109 (8.6) | 97 (9.6) | 12 (4.7) |
eGFR < 15 (%) | 24 (1.9) | 19 (1.8) | 5 (2.0) |
Atrial fibrillation (%) | 451 (35.6) | 349 (34.5) | 102 (40.2) |
Pleural effusion (%) | 404 (31.9) | 322 (31.8) | 82 (32.3) |
Hospitalization time (days) | 13 (9–18) | 13 (8–17) | 15 (10–20) |
Outcomes
| |||
Composite endpoint (%) | 181 (14.3) | 144 (14.2) | 37 (14.6) |
In-hospital death (%) | 117 (9.2) | 93 (9.2) | 24 (9.4) |
In-hospital cardiac arrest (%) | 48 (3.8) | 41 (4.0) | 7 (2.8) |
Applications of IABP or ECMO (%) | 16 (1.3) | 10 (1.0) | 6 (2.4) |
Heart transplantation (%) | 45 (3.5) | 32 (3.2) | 13 (5.1) |
Logistic regression and model establishment
Variable | Univariate | Multivariate | Model selection | |||
---|---|---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | β value | Score | |
Female gender | 0.838 (0.576–1.221) | 0.358 | ||||
Age | 0.993 (0.983–1.003) | 0.183 | ||||
Age ≥ 75 years | 0.923 (0.576–1.478) | 0.738 | ||||
BMI (kg/m2) | ||||||
Normal | 0 | 1 | ||||
Underweight | 1.713 (0.970–3.024) | 0.064 | ||||
Overweight | 0.810 (0.509–1.289) | 0.375 | ||||
Obese | 0.651 (0.357–1.188) | 0.162 | ||||
GCS | 1.875 (1.490–2.357) | < 0.001 | ||||
Temperature | 0 | 0.999 | ||||
SBP | ||||||
SBP < 90 mmHg | 5.927 (2.75–12.762) | < 0.001 | 4.636 (1.881–11.426) | 0.001 | 1.534 | 1 |
SBP ≥ 140 mmHg | 1.403 (0.765–2.575) | 0.274 | 0.943 (0.352–2.530) | 0.908 | ||
HR (bpm) | ||||||
70 ≤ HR < 110 | 0 | 1 | ||||
HR < 55 | 1.17 (0.574–2.386) | 0.666 | ||||
55 ≤ HR < 70 | 0.848 (0.541–1.33) | 0.473 | ||||
110 ≤ HR < 159 | 2.142 (1.228–3.736) | 0.007 | ||||
RR (min−1) | ||||||
24 < RR ≤ 34 | 1.385 (0.631–3.041) | 0.461 | ||||
RR > 34 | 1 | |||||
pH | 0.322 (0.078–1.333) | 0.118 | ||||
PaO2 | ||||||
60 < PaO2 ≤ 70 | 0.580 (0.213–1.581) | 0.287 | ||||
55 < PaO2 ≤ 60 | 1.181 (0.41–3.404) | 0.758 | ||||
PaO2 ≤ 55 | 0.706 (0.191–2.614) | 0.602 | ||||
AB | ||||||
AB < 22 mmol/l | 2.017 (1.295–3.142) | 0.002 | ||||
AB > 28 mmol/l | 1.975 (1.193–3.272) | 0.008 | ||||
Lactic acid > 2.1 mmol/l | 3.047 (1.904–4.876) | < 0.001 | ||||
Serum sodium < 136.1 mmol/l | 2.530 (1.742–3.674) | < 0.001 | ||||
Serum potassium | ||||||
Hypokalemia | 0.797 (0.497–1.277) | 0.345 | ||||
Hyperkalemia | 4.55 (1.513–13.682) | 0.007 | ||||
WBC > 9.2 × 109/L | 6.036 (4.151–8.776) | < 0.001 | 6.742 (3.719–12.223) | < 0.001 | 1.908 | 2 |
Anemia | 1.512 (1.052–2.174) | 0.025 | ||||
HCT ≤ 40.7% | 1.96 (1.365–2.814) | < 0.001 | 2.915 (1.598–5.319) | < 0.001 | 1.070 | 1 |
TBIL > 34.2 μmol/l | 3.037 (2.111–4.370) | < 0.001 | 5.929 (3.225–10.899) | < 0.001 | 1.780 | 2 |
SUA > 547.9 μmol/l | 2.662 (1.850–3.830) | < 0.001 | ||||
D-dimer > 0.92 mg/l | 4.018 (2.651–6.090) | < 0.001 | ||||
INR > 1.145 | 3.354 (2.195–5.124) | < 0.001 | ||||
hs-TNI | 1.041 (0.988–1.096) | 0.136 | ||||
LVEF | ||||||
HFpEF | 0 | 1 | ||||
HFmrEF | 0.548 (0.281–1.068) | 0.077 | ||||
HFrEF | 0.936 (0.621–1.411) | 0.752 | ||||
PASP | ||||||
PASP ≤ 30 mmHg | 0 | 1 | ||||
30 < PASP ≤ 50 mmHg | 1.078 (0.671–1.732) | 0.757 | ||||
50 < PASP ≤ 70 mmHg | 0.965 (0.602–1.547) | 0.883 | ||||
PASP > 70 mmHg | 2.638 (1.381–5.039) | 0.003 | ||||
Pleural effusion | 2.016 (1.408–2.887) | < 0.001 | ||||
AF | 0.830 (0.567–1.216) | 0.34 | ||||
BBB | 0.756 (0.480–1.190) | 0.227 | ||||
eGFR (ml/min/1.73 m2) | ||||||
eGFR ≥ 90 | 0 | 1 | 0 | 1 | ||
60 ≤ eGFR < 90 | 0.940 (0.502–1.760) | 0.846 | 0.516 (0.217–1.226) | 0.134 | ||
30 ≤ eGFR < 60 | 1.745 (1.014–3.003) | 0.044 | 1.205 (0.555–2.615) | 0.638 | ||
15 ≤ eGFR < 30 | 2.412 (1.210–4.808) | 0.012 | 0.773 (0.251–2.378) | 0.653 | ||
eGFR < 15 | 6.395 (2.23–18.334) | 0.001 | 5.374 (1.116–25.881) | 0.036 | 1.681 | 2 |
NT-proBNP (ng/ml) | ||||||
NT-proBNP < 2171.3 | 0 | 1 | 0 | 1 | ||
2171.3 ≤ NT-proBNP < 4966.5 | 1.593 (0.724–3.505) | 0.247 | 1.517 (0.583–3.949) | 0.393 | ||
4966.5 ≤ NT-proBNP < 10,728.9 | 2.018 (0.943–4.320) | 0.071 | 0.867 (0.324–2.320) | 0.777 | ||
NT-proBNP ≥ 10,728.9 | 6.049 (3.03–12.073) | < 0.001 | 2.920 (1.188–7.179) | 0.02 | 1.072 | 1 |