Key result
Elevated JVP linked to ~5.2-fold higher in-hospital mortality in ADHF.
Why the study?
Acute decompensated heart failure with reduced ejection fraction carries substantial short-term risk, motivating evaluation of routinely available clinical, hematologic, and electrocardiographic factors associated with in-hospital mortality and severe pre-admission functional limitation.
Are routinely available clinical, hematologic, and electrocardiographic markers at admission associated with in-hospital mortality and severe pre-admission functional limitation in patients hospitalized with acute decompensated HFrEF?
Cohort (n=100)
No
Are routinely available clinical, hematologic, and electrocardiographic markers at admission associated with in-hospital mortality and severe pre-admission functional limitation in patients hospitalized with acute decompensated HFrEF?
Answers are grounded in this paper and cite their sources.
Readily available bedside clinical, hematologic, and ECG parameters—specifically elevated JVP, leukocytosis, and QTc prolongation—are associated with in-hospital mortality in acute decompensated HFrEF, though external validation in larger cohorts is required.
Acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF) carries substantial short-term risk. We evaluated routinely available clinical, hematologic, and electrocardiographic factors associated with in-hospital mortality and severe pre-admission functional limitation. This retrospective cohort included 100 adults hospitalized with ADHF and HFrEF. In-hospital death was the primary outcome. Because 16 deaths occurred, mortality associations were estimated using a three-variable Firth penalized logistic model including elevated jugular venous pressure (JVP), white blood cell (WBC) count, and Bazett-corrected QTc. Model discrimination, calibration, Brier score, and 1,000-resample bootstrap internal validation were assessed. Severe pre-admission functional limitation was analyzed as NYHA class IV versus classes II–III using a separate three-variable binary logistic model. Broad univariable analyses were exploratory and were adjusted using the Benjamini–Hochberg false-discovery-rate procedure. Sixteen patients (16%) died during hospitalization and 45 had NYHA class IV before admission. Elevated JVP (OR 5.19, 95% profile penalized-likelihood CI 1.23–22.31; p = 0.026), higher WBC count (OR 1.27 per 1 × 10 9 /L, 95% CI 1.04–1.62; p = 0.013), and longer QTc (OR 1.18 per 10 ms, 95% CI 1.04–1.36; p = 0.009) were associated with in-hospital mortality. The apparent AUC was 0.819 (bootstrap 95% CI 0.677–0.933) and the optimism-corrected AUC was 0.794; the corrected calibration slope was 0.953 and Brier score 0.114. NYHA class IV was associated with abnormal lung sounds (OR 4.44, 95% CI 1.44–13.65; p = 0.009), a tricuspid/mitral regurgitation murmur (OR 3.21, 95% CI 1.30–7.93; p = 0.012), and lower alkaline phosphatase (OR 0.58 per 100 U/L increase, 95% CI 0.39–0.87; p = 0.008). No exploratory univariable association remained significant after false-discovery-rate correction. In this small single-center cohort, JVP, WBC count, and QTc showed adjusted associations with in-hospital mortality, while pulmonary findings, valvular murmurs, and alkaline phosphatase were associated with severe pre-admission functional limitation. External validation is required before clinical use.
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Imani et al. (2026) conducted a cohort in Acute decompensated heart failure with reduced ejection fraction (HFrEF) (n=100). Elevated jugular venous pressure (JVP), higher WBC count, and longer QTc vs. Normal JVP, lower WBC count, and normal QTc was evaluated on In-hospital all-cause mortality (associated with elevated JVP in Firth penalized logistic model) (OR 5.19, 95% CI 1.23-22.31, p=0.026). Elevated jugular venous pressure, higher WBC count, and longer QTc were independently associated with in-hospital mortality in ADHF.
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