Tersiyer bir merkezde akut kalp yetersizlikli hastalarda hastane içi mortaliteye etkili faktörlerin belirlenmesi
Küçük Resim Yok
Tarih
2008
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Son yıllarda tedavi yöntemlerindeki gelişmelere rağmen kardiyovasküler mortalite ve morbiditenin en önemli nedeni akut kalp yetersizliğidir (AKY). Kalp yetersizliği nedeniyle hastaneye yatırılan hastalar sol ventrikül sistolik fonksiyonundan bağımsız olarak kısa dönem prognozu kötü olan yüksek riskli popülasyonu oluşturmaktadır. Kalp yetersizliği ile ilişkili mortalitenin önemli bir kısmı hastanedeki yatışlar sırasında gerçekleşmektedir. Bu çalışmada AKY hastalarında hastane içi mortalite ile ilişkili faktörler araştırılmıştır. Yöntemler: Çalışmaya Aralık 2005-Mart 2007 arasında ardışık 85 AKY (yaş ortalaması 64±8 yıl, %54’ü erkek) hastası alındı. Retrospektif olarak demografik, klinik, elektrokardiyografik ve ekokardiyografik özelliklerin ve laboratuvar bulgularının hastane içi mortaliteye etkisi değerlendirildi. Bulgular: Hastaların %24.7’si yeni başlayan kalp yetersizliği (KY) olarak değerlendirildi. Koroner arter hastalığı (%61) en sık altta yatan hastalıktı. Hastaların %44.7’sinde hipertansiyon, %37.6’sında diyabetes mellitüs, %21’inde kronik böbrek yetersizliği, %16.4’ünde kronik obstrüktif akciğer hastalığı mevcuttu. Ortalama sol ventrikül ejeksiyon fraksiyonu %35±7 idi. Hastane içi mortalite oranı %11.7 (10 hasta) olarak bulundu. Mortalitenin ana nedeni (%60) KY’nin kardiyojenik şoka ilerlemesiydi. Hastane içinde kaybedilen hastalar sağ kalanlarla klinik, demografik, laboratuvar ve elektrokardiyografik özellikleri ile sol ve sağ ventrikül fonksiyonları açısından karşılaştırıldığında kan üre azotu (45±20 mg/dl’ye karşılık 36±12 mg/dl, p=0.04), kreatinin (2.2±0.8 mg/dl’ye karşılık 1.1±0.5 mg/dl, p=0.001), QRS süresi (130±13 msn’ye karşılık 116±18 msn, p=0.04) anlamlı olarak daha yüksek olup, serum sodyumu daha düşük (128±5 mmol/l’ye karşılık 135±9 mmol/l, p=0.02) ve sistolik kan basıncı kaybedilen hastaların %50’sinde <90 mm Hg idi (p=0.01). Lojistik regresyon analizinde serum kreatinin düzeyi (OR 1.5, %95 GA 1.2-2.1, p=0.01), kan üre azotu (OR 2.1, %95 GA 1.8-3.1, p=0.001), serum sodyum düzeyi (OR 1.3, %95 GA 1.1-1.7, p=0.02) ve sistolik kan basıncının (OR 2.2, %95 GA 1.9-2.8, p=0.01) mortalitenin bağımsız öngördürücüleri oldukları saptandı. Sonuç: Hastaneye başvuruda düşük sistolik kan basıncı, düşük plazma sodyum düzeyi ve böbrek yetmezliği olan hastalarda hastane içi mortalite artmaktadır.
Objective: Despite impressive advances in therapeutics in the last years, acute heart failure (AHF) remains a major cause of cardiovascular morbidity and mortality. Patients hospitalized because of heart failure (HF), irrespective of left ventricular systolic function, represent a high-risk population with limited short-term prognosis. A substantial component of HF-related mortality occurs during a hospital stay. In this study, we aimed to determine the factors impacting on in-hospital mortality in patients with AHF. Methods: During a 15-month period (December 2005-March 2007), 85 consecutive patients with (mean age: 64±8 years, male: 54%) an episode of AHF were included in this study. The effect of demographic, clinical, electrocardiographic, and echocardiographic characteristics, laboratory findings on in-hospital mortality were evaluated retrospectively. Results: Of 85 patients 24.7% of patients had new-onset HF. Coronary artery disease (61%) was the most common underlying disease. The 44.7% of patients had hypertension, 37.6% had diabetes mellitus, 21% had chronic renal failure and 16.4% had chronic obstructive pulmonary disease. Left ventricular ejection fraction was 35±7%. In-hospital mortality rate was found as 11.7% (10 patients).The major cause of mortality was the progression of HF to cardiogenic shock in 60% of deaths. In comparison with surviving patients in terms of the clinical, demographic, electrocardiographic, and laboratory characteristics and left and right ventricular functions, patients died during hospitalization had higher blood urea nitrogen (45±20 mg/dl vs. 36±12 mg/dl, p=0.04), higher creatinine level (2.2±0.8 mg/dl vs. 1.1±0.5 mg/dl, p=0.001), and wider QRS duration (130±13 ms vs. 116±18 ms, p=0.04) whereas they had lower plasma sodium level (128±5 mmol/l vs. 135±9 mmol/l, p=0.02) and systolic blood pressure (p=0.01). Logistic regression analysis revealed that plasma creatinine level (OR 1.5, 95% CI 1.2 to 2.1, p=0.01), blood urea nitrogen (OR 2.1, 95% CI 1.8 to 3.1, p=0.001), plasma sodium level (OR 1.3, 95% CI 1.1 to 1.7, p=0.02), and systolic blood pressure (OR 2.2, 95% CI 1.9 to 2.8, p=0.01) were the independent predictors of in-hospital mortality. Conclusion: In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.
Objective: Despite impressive advances in therapeutics in the last years, acute heart failure (AHF) remains a major cause of cardiovascular morbidity and mortality. Patients hospitalized because of heart failure (HF), irrespective of left ventricular systolic function, represent a high-risk population with limited short-term prognosis. A substantial component of HF-related mortality occurs during a hospital stay. In this study, we aimed to determine the factors impacting on in-hospital mortality in patients with AHF. Methods: During a 15-month period (December 2005-March 2007), 85 consecutive patients with (mean age: 64±8 years, male: 54%) an episode of AHF were included in this study. The effect of demographic, clinical, electrocardiographic, and echocardiographic characteristics, laboratory findings on in-hospital mortality were evaluated retrospectively. Results: Of 85 patients 24.7% of patients had new-onset HF. Coronary artery disease (61%) was the most common underlying disease. The 44.7% of patients had hypertension, 37.6% had diabetes mellitus, 21% had chronic renal failure and 16.4% had chronic obstructive pulmonary disease. Left ventricular ejection fraction was 35±7%. In-hospital mortality rate was found as 11.7% (10 patients).The major cause of mortality was the progression of HF to cardiogenic shock in 60% of deaths. In comparison with surviving patients in terms of the clinical, demographic, electrocardiographic, and laboratory characteristics and left and right ventricular functions, patients died during hospitalization had higher blood urea nitrogen (45±20 mg/dl vs. 36±12 mg/dl, p=0.04), higher creatinine level (2.2±0.8 mg/dl vs. 1.1±0.5 mg/dl, p=0.001), and wider QRS duration (130±13 ms vs. 116±18 ms, p=0.04) whereas they had lower plasma sodium level (128±5 mmol/l vs. 135±9 mmol/l, p=0.02) and systolic blood pressure (p=0.01). Logistic regression analysis revealed that plasma creatinine level (OR 1.5, 95% CI 1.2 to 2.1, p=0.01), blood urea nitrogen (OR 2.1, 95% CI 1.8 to 3.1, p=0.001), plasma sodium level (OR 1.3, 95% CI 1.1 to 1.7, p=0.02), and systolic blood pressure (OR 2.2, 95% CI 1.9 to 2.8, p=0.01) were the independent predictors of in-hospital mortality. Conclusion: In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi
Kaynak
Anadolu Kardiyoloji Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
8
Sayı
4
