Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

作者：Cubo Romano Pilar; Torres Macho Juan; Soni Nilam J; Reyes Luis F; Rodriguez Almodovar Ana; Manuel Fernandez Alonso Juan; Gonzalez Davia Rosa; Manuel Casas Rojo Jose; Restrepo Marcos I; Garcia de Casasola Gonzalo

来源：Journal of Hospital Medicine, 2016, 11(11): 778-784.

DOI：10.1002/jhm.2620

BACKGROUNDPrognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF.
OBJECTIVEThe objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF.
DESIGNProspective observational study.
SETTINGA 247-bed urban teaching hospital in Spain
PATIENTSNinety-seven patients hospitalized with ADHF.
INTERVENTIONNone.
MEASUREMENTSThe IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90-day all-cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180-day all-cause mortality. Patients were followed for 180 days.
RESULTSData from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90-day follow-up period, 11 patients (13.7%) died. An admission IVCmax diameter 1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90-day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21-28.10; P = 0.025) and 90-day readmission (HR: 3.20; 95% CI: 1.24-8.21; P = 0.016).
CONCLUSIONIn patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90-day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778-784.

• 出版日期2016-11