Study On The Related Factors Of In-Hospital Death In Patients With Chronic Heart Failure

Objective:This study aims to explore the risk factors of in-hospital death in patients with chronic heart failure(CHF),and to provide theoretical basis for early identification of high risk patients and intervention measures.Methods:The clinical data of chronic heart failure patients admitted to the affiliated Hospital of Binzhou Medical University from January 2014 to December 2017 were collected,including age,sex,basic heart disease,laboratory parameters(complete blood count,blood chemistries,N-terminal pro-brain natriuretic peptide,troponin I,et al),left ventricular ejection fraction.According to the living conditions in hospital,they were divided into in-hospital death group(n=43)and survival group(n=359).Univariate Logistic regression analysis was used to obtain the related influencing factors of in-hospital death of chronic heart failure patients.The independent influencing factors of in-hospital death of chronic heart failure patients were obtained by multivariate Logistic regression analysis,and the independent influencing factors were analyzed by Receiver Operating Characteristic Curve analysis to evaluate their predictive value.Results:A total of 402 chronic heart failure patients were enrolled in this study.There were 187 cases with ischemic heart disease,72 cases with dilated cardiomyopathy,98 cases with hypertensive heart disease and 45 cases with valvular heart disease.The age,white blood cell,neutrophil,neutrophil/lymphocyte ratio,red cell distribution width,blood urea nitrogen,troponin 1,NT-proBNP,heart rate on admission in the in-hospital death group were significantly higher than those in the survival group(P<0.05).Lymphocytes,erythrocytes,hemoglobin,hematocrit,albumin and serum sodium were significantly lower in the in-hospital death group than those in the survival group(P<0.05).There was no significant difference in sex,basic heart disease,total bilirubin,serum creatinine,serum potassium,left ventricular ejection fraction,systolic pressure and diastolic pressure between the two groups(P>0.05).Univariate Logistic regression analysis was used to screen the influencing factors of in-hospital death in patients with chronic heart failure,including age,white blood cells,neutrophils,lymphocytes,NLR,red blood cell,hemoglobin,red blood cell distribution width,hematocrit,albumin,blood urea nitrogen,serum sodium,troponin I,NT-proBNP.Multivariate Logistc regression analysis showed that age,NLR,red cell distribution width,blood urea nitrogen,troponin Ⅰ and NT-proBNP were the independent risk factors for in-hospital death of chronic heart failure patients in this study.Albumin was the protective factor.The predictive value of independent influencing factors was analyzed by ROC separately.The results showed that NLR,troponin Ⅰ,NT-proBNP and blood urea nitrogen had higher predictive value for in-hospital death in patients with chronic heart failure.Conclusion:High levels of NLR,red cell distribution width,blood urea nitrogen,troponin Ⅰ,NT-proBNP,old age and low albumin levels suggest poor prognosis in chronic heart failure patients.Clinically,early identification of high-risk chronic heart failure patients should be strengthened and intervention measures should be taken to reduce in-hospital death and economic burden.