AimsAcute heart failure (AHF) can result in worsening of heart failure (WHF), cardiogenic shock (CS), or death. Risk factors for these adverse outcomes are not well characterized. This study aimed to identify predictors for WHF or new‐onset CS in patients hospitalized for AHF.Methods and resultsProspective cohort study enrolling consecutive patients with AHF admitted to a large tertiary care centre with follow‐up until death or discharge. WHF was defined by the RELAX‐AHF‐2 criteria. CS was defined as SCAI stages B–E. Potential predictors were assessed by fitting logistic regression models adjusted for age and sex. N = 233 patients were enrolled, median age was 78 years, and 80 were women (35.9%). Ischaemic cardiomyopathy was present in 82 patients (40.8%). Overall, 96 (44.2%) developed WHF and 18 (9.7%) CS. In‐hospital death (8/223, 3.6%) was related to both events (WHF: OR 6.64, 95% CI 1.21–36.55, P = 0.03; CS: OR 38.27, 95% CI 6.32–231.81, P < 0.001). Chronic kidney disease (OR 2.20, 95% CI 1.25–3.93, P = 0.007), logarithmized serum creatinine (OR 2.90, 95% CI 1.51–5.82, P = 0.002), cystatin c (OR 1.86, 95% CI 1.27–2.77, P = 0.002), tricuspid valve regurgitation (OR 2.08, 95% CI 1.11–3.94, P = 0.023) and logarithmized pro‐adrenomedullin (OR 3.01, 95% CI 1.75–5.38, P < 0.001) were significant predictors of WHF. Chronic kidney disease (OR 3.17, 95% CI 1.16–9.58, P = 0.03), cystatin c (OR 1.88, 95% CI 1.00–3.53, P = 0.045), logarithmized pro‐adrenomedullin (OR 2.90, 95% CI 1.19–7.19, P = 0.019), and tricuspid valve regurgitation (OR 10.44, 95% CI 2.61–70.00, P = 0.003) were significantly with new‐onset CS.ConclusionsHalf of patients admitted with AHF experience WHF or new‐onset CS. Chronic kidney disease, tricuspid valve regurgitation, and elevated pro‐adrenomedullin concentrations predict these events. They could potentially serve as early warning signs for further deterioration in AHF patients.

中文翻译：

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急性心力衰竭患者心脏恶化直至心源性休克的预测

目的急性心力衰竭 (AHF) 可导致心力衰竭 (WHF) 恶化、心源性休克 (CS) 或死亡。这些不良后果的风险因素尚未得到很好的描述。本研究旨在确定因 AHF 住院患者的 WHF 或新发 CS 的预测因素。方法和结果前瞻性队列研究纳入了入住大型三级护理中心的连续 AHF 患者，并随访直至死亡或出院。 WHF 由 RELAX-AHF-2 标准定义。 CS 被定义为 SCAI B–E 阶段。通过根据年龄和性别调整的逻辑回归模型来评估潜在的预测因素。氮= 233 名患者入组，中位年龄为 78 岁，其中 80 名患者为女性 (35.9%)。 82 名患者 (40.8%) 患有缺血性心肌病。总体而言，96 名 (44.2%) 发生了 WHF，18 名 (9.7%) 发生了 CS。院内死亡（8/223，3.6%）与这两种事件相关（WHF：OR 6.64，95% CI 1.21-36.55，磷= 0.03; CS：OR 38.27，95% CI 6.32–231.81，磷< 0.001)。慢性肾脏病（OR 2.20，95% CI 1.25–3.93，磷= 0.007），对数血清肌酐（OR 2.90，95% CI 1.51–5.82，磷= 0.002)，半胱氨酸蛋白酶抑制剂 c (OR 1.86，95% CI 1.27–2.77，磷= 0.002），三尖瓣关闭不全（OR 2.08，95% CI 1.11–3.94，磷= 0.023）和对数肾上腺髓质素原（OR 3.01，95% CI 1.75–5.38，磷< 0.001) 是 WHF 的显着预测因子。慢性肾脏病（OR 3.17，95% CI 1.16–9.58，磷= 0.03), 半胱氨酸蛋白酶抑制剂 c (OR 1.88, 95% CI 1.00–3.53,磷= 0.045），对数肾上腺髓质素原（OR 2.90，95% CI 1.19–7.19，磷= 0.019）和三尖瓣关闭不全（OR 10.44，95% CI 2.61–70.00，磷= 0.003）与新发 CS 显着相关。结论 因 AHF 入院的患者中有一半经历过 WHF 或新发 CS。慢性肾脏疾病、三尖瓣反流和肾上腺髓质素原浓度升高可预测这些事件。它们可能成为急性心力衰竭患者病情进一步恶化的早期预警信号。