Key result
Combining novel predictors (low albumin, elevated creatinine, small IVC diameter, and catecholamine infusion) with the GWTG-HF risk score improved the prediction of in-hospital death in heart failure patients treated with tolvaptan.
Observational (n=61)
No
In patients with worsening heart failure treated with tolvaptan, a GWTG-HF risk score >47, albumin ≤2.4 g/dL, creatinine >1.5 mg/dL, IVC diameter ≤15 mm, and catecholamine infusion were identified as independent predictors of in-hospital mortality.
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May aid risk stratification in tolvaptan-treated HF; hypothesis-generating and requires prospective validation.
Objectives: There are well-established risk prediction models of in-hospital mortality due to heart failure (HF).However, the predictors of mortality during acute hospitalization in individuals with HF receiving tolvaptan, a vasopressin type 2 receptor antagonist, are poorly understood.Methods: Sixty-one hospitalized patients prescribed tolvaptan to treat worsening HF were consecutively enrolled in this study.The study endpoint was death during hospitalization.Results: Compared with survivors, patients who died in hospital had higher Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, decreased albumin levels, increased serum creatinine levels, smaller inferior vena cava (IVC) diameters on echocardiography, and were more likely to have received catecholamine infusion.A multivariate logistic regression analysis revealed that in addition to GWTG-HF risk score >47, albumin level ≤2.4 g/dL, creatinine level >1.5 mg/dL, IVC diameter ≤15 mm, and catecholamine infusion were all novel and significant predictors of inhospital death.Moreover, combining these novel predictors to the GWTG-HF risk score significantly improved prediction of in-hospital death, as shown by the greater area under the receiver operating characteristic (ROC) curve.Conclusions: In patients with worsening HF receiving oral tolvaptan, we identified novel predictors of in-hospital death.Our findings may be helpful in developing novel treatment strategies for patients receiving tolvaptan for HF in clinical settings.
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Ito et al. (2018) conducted an observational in Worsening heart failure (n=61). Novel predictors (albumin ≤2.4 g/dL, creatinine >1.5 mg/dL, IVC diameter ≤15 mm, catecholamine infusion) added to GWTG-HF risk score vs. GWTG-HF risk score alone was evaluated on Prediction of in-hospital death (Area under the ROC curve) (p=<0.001). Combining novel predictors (low albumin, elevated creatinine, small IVC diameter, and catecholamine infusion) with the GWTG-HF risk score improved the prediction of in-hospital death in heart failure patients treated with tolvaptan.
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