Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study
Objective Congestive heart failure (CHF) is a clinical syndrome in which the heart disease progresses to a severe stage. Early diagnosis and risk assessment of death of patients with CHF are critical to prognosis and treatment. The purpose of this study was to establish a nomogram that predicts the...
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BMJ Publishing Group
2022-07-01
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| author | Tao Huang Rui Yang Jun Lyu Didi Han Fengshuo Xu Shuai Zheng Luming Zhang Haiyan Yin |
| author_facet | Tao Huang Rui Yang Jun Lyu Didi Han Fengshuo Xu Shuai Zheng Luming Zhang Haiyan Yin |
| author_sort | Tao Huang |
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| description | Objective Congestive heart failure (CHF) is a clinical syndrome in which the heart disease progresses to a severe stage. Early diagnosis and risk assessment of death of patients with CHF are critical to prognosis and treatment. The purpose of this study was to establish a nomogram that predicts the in-hospital death of patients with CHF in the intensive care unit (ICU).Design A retrospective observational cohort study.Setting and participants Data for the study were from 30 411 patients with CHF in the Medical Information Mart for Intensive Care database and the eICU Collaborative Research Database (eICU-CRD).Primary outcome In-hospital mortality.Methods Univariate logistic regression analysis was used to select risk factors associated with in-hospital mortality of patients with CHF, and multivariate logistic regression was used to build the prediction model. Discrimination, calibration and clinical validity of the model were evaluated by AUC, calibration curve, Hosmer-Lemeshow χ2 test and decision curve analysis, respectively. Finally, data from 15 503 patients with CHF in the multicentre eICU-CRD were used for external validation of the established nomogram.Results The inclusion criteria were met by 15 983 subjects, whose in-hospital mortality rate was 12.4%. Multivariate analysis determined that the independent risk factors were age, race, norepinephrine, dopamine, phenylephrine, vasopressin, mechanical ventilation, intubation, hepatic failure (HepF), heart rate, respiratory rate, temperature, systolic blood pressure (SBP), anion gap (AG), blood urea nitrogen (BUN), creatinine, chloride, mean corpuscular volume (MCV), red blood cell distribution width (RDW) and white cell count (WCC). The C-index of the nomogram (0.767, 95% CI 0.759 to 0.779) was superior to that of the traditional Sequential Organ Failure Assessment, Acute Physiology Score III and Get With The Guidelines Heart Failure scores, indicating its discrimination power. Calibration plots demonstrated that the predicted results are in good agreement with the observed results. The decision curves of the derivation and validation sets both had net benefits.Conclusion The 20 independent risk factors for in-hospital mortality of patients with CHF were age, race, norepinephrine, dopamine, phenylephrine, vasopressin, mechanical ventilation, intubation, HepF, heart rate, respiratory rate, temperature, SBP, AG, BUN, creatinine, chloride, MCV, RDW and WCC. The nomogram, which included these factors, accurately predicted the in-hospital mortality of patients with CHF. The novel nomogram has the potential for use in clinical practice as a tool to predict and assess mortality of patients with CHF in the ICU. |
| format | Article |
| id | doaj-art-ec6cc51124d245aeb6f324a7066c16ea |
| institution | Kabale University |
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| language | English |
| publishDate | 2022-07-01 |
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| spelling | doaj-art-ec6cc51124d245aeb6f324a7066c16ea2025-01-31T02:50:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-059761Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort studyTao Huang0Rui Yang1Jun Lyu2Didi Han3Fengshuo Xu4Shuai Zheng5Luming Zhang6Haiyan Yin71 Department of Epidemiology and Biostatistics, Peking University, Beijing, ChinaIntensive Care Unit, Jinan University First Affiliated Hospital, Guangzhou, ChinaGuangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Jinan University, Guangzhou, People`s Republic of ChinaIntensive Care Unit, Jinan University First Affiliated Hospital, Guangzhou, ChinaIntensive Care Unit, Jinan University First Affiliated Hospital, Guangzhou, ChinaIntensive Care Unit, Jinan University First Affiliated Hospital, Guangzhou, ChinaIntensive Care Unit, Jinan University First Affiliated Hospital, Guangzhou, ChinaIntensive Care Unit, Jinan University First Affiliated Hospital, Guangzhou, ChinaObjective Congestive heart failure (CHF) is a clinical syndrome in which the heart disease progresses to a severe stage. Early diagnosis and risk assessment of death of patients with CHF are critical to prognosis and treatment. The purpose of this study was to establish a nomogram that predicts the in-hospital death of patients with CHF in the intensive care unit (ICU).Design A retrospective observational cohort study.Setting and participants Data for the study were from 30 411 patients with CHF in the Medical Information Mart for Intensive Care database and the eICU Collaborative Research Database (eICU-CRD).Primary outcome In-hospital mortality.Methods Univariate logistic regression analysis was used to select risk factors associated with in-hospital mortality of patients with CHF, and multivariate logistic regression was used to build the prediction model. Discrimination, calibration and clinical validity of the model were evaluated by AUC, calibration curve, Hosmer-Lemeshow χ2 test and decision curve analysis, respectively. Finally, data from 15 503 patients with CHF in the multicentre eICU-CRD were used for external validation of the established nomogram.Results The inclusion criteria were met by 15 983 subjects, whose in-hospital mortality rate was 12.4%. Multivariate analysis determined that the independent risk factors were age, race, norepinephrine, dopamine, phenylephrine, vasopressin, mechanical ventilation, intubation, hepatic failure (HepF), heart rate, respiratory rate, temperature, systolic blood pressure (SBP), anion gap (AG), blood urea nitrogen (BUN), creatinine, chloride, mean corpuscular volume (MCV), red blood cell distribution width (RDW) and white cell count (WCC). The C-index of the nomogram (0.767, 95% CI 0.759 to 0.779) was superior to that of the traditional Sequential Organ Failure Assessment, Acute Physiology Score III and Get With The Guidelines Heart Failure scores, indicating its discrimination power. Calibration plots demonstrated that the predicted results are in good agreement with the observed results. The decision curves of the derivation and validation sets both had net benefits.Conclusion The 20 independent risk factors for in-hospital mortality of patients with CHF were age, race, norepinephrine, dopamine, phenylephrine, vasopressin, mechanical ventilation, intubation, HepF, heart rate, respiratory rate, temperature, SBP, AG, BUN, creatinine, chloride, MCV, RDW and WCC. The nomogram, which included these factors, accurately predicted the in-hospital mortality of patients with CHF. The novel nomogram has the potential for use in clinical practice as a tool to predict and assess mortality of patients with CHF in the ICU.https://bmjopen.bmj.com/content/12/7/e059761.full |
| spellingShingle | Tao Huang Rui Yang Jun Lyu Didi Han Fengshuo Xu Shuai Zheng Luming Zhang Haiyan Yin Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study BMJ Open |
| title | Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study |
| title_full | Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study |
| title_fullStr | Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study |
| title_full_unstemmed | Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study |
| title_short | Early prediction of in-hospital mortality in patients with congestive heart failure in intensive care unit: a retrospective observational cohort study |
| title_sort | early prediction of in hospital mortality in patients with congestive heart failure in intensive care unit a retrospective observational cohort study |
| url | https://bmjopen.bmj.com/content/12/7/e059761.full |
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