Hemodynamic support in acute decompensated heart failure: clinical and laboratory characteristics, predictors of unfavorable prognosis

Introduction . Acute decompensation of chronic heart failure (ADCHF) is one of the leading causes of hospitalization in cardiac intensive care units (ICUs), associated with high mortality (up to 43% in the first year). The prognosis for patients requiring inotropic and/or vasopressor drugs is particularly unfavorable, creating a need to improve risk stratification methods. Objective. To develop a model for predicting the need for inotropic and/or vasopressor therapy in patients with acute decompensation of chronic heart failure. Methods. A prospective cohort study of 140 patients in the ICU. An analysis of clinicaldemographic, laboratory, and instrumental data was performed using multivariate logistic regression and ROC-analysis. Results. A highly accurate model was created (AUROC 0.96), including three independent predictors: creatinine level >136.9 µmol/L (OR=22.32), alkaline phosphatase >120.1 U/L (OR=41.78), and the assessment of the HF phenotype. At a threshold of 9 points, the model’s sensitivity was 100%, specificity — 79%. Mortality in the group requiring support was significantly higher (32% vs.12.2%). Conclusion . The model allows for accurate risk stratification of the need for inotropic/vasopressor drugs, which is especially important in emergency care settings and opens up opportunities for changing approaches to pharmacotherapy in patients with ADHF.