Development and Validation of a Simple-to-use Nomogram for Predicting In-hospital Mortality in Acute Heart Failure Patients Undergoing Continuous Renal Replacement Therapy

in-hospital mortality

Acute heart failure (AHF) is one of the most common causes of hospitalization and
 life-threatening medical condition around worldwide. The AHF patients admitted to the
 intensive care unit (ICU) usually be critically ill with multiorgan failure, in which the
 kidneys are most frequently involved. The goals of treatment of AHF in ICU were to improve
 hemodynamic stability and organ perfusion, alleviate symptoms, and limit cardiac and renal
 damage, which can be achieved by continuous renal replacement therapy (CRRT), a continuous
 extracorporeal blood purification. CRRT can mimic urine output to slowly and continuously
 remove patient's plasma water, providing accurate volume control and hemodynamic stability.
 
 Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF) study showed that hospital
 mortality of AHF patients was about 17.8% in the intensive care unit (ICU). But the patients
 undergoing CRRT, the mortality up to 45%-62.1%. For this reason, an early model or score to a
 screening of AHF patients undergoing CRRT who at high mortality risk is crucial, which can
 help clinicians to rapidly intervene and ameliorate disease outcomes. The most popular tools,
 especially that can predict mortality for critically ill patients, are the Acute Physiology
 Assessment and Chronic Health Evaluation II (APACHE II) scoring systems, and Simplified Acute
 Physiologic Score II (SAPS II). But variables in these scoring systems are complex, which was
 not convenient to assess at any time. Modified Early Warning Score (MEWS) , much more concise
 than APACHE II and SAPS II, not only can be used for early warning of the onset of AHF in
 patients with the risk of heart failure but also has a positive correlation with mortality in
 these patients. However, up to our knowledge, there was no scores or model to predict the
 in-hospital mortality of AHF patient undergoing CRRT.
 
 Based on the acute heart failure unit (AHFU) of Qilu Hospital and the medical information
 mart for intensive care III (MIMIC III) database, the investigators collected the data of AHF
 adults undergoing CRRT. The present study aimed to develop and validate a simple-to-use
 nomogram model comprised of independent prognostic variables for predicting in-hospital
 mortality in AHF adults undergoing CRRT by using multivariate logistic regression analysis.
 With this model, the investigators can guide the early screening of high-risk patients in
 in-hospital mortality.