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One‑year survival of ambulatory patients with end‑stage heart failure: the analysis of prognostic factors.

One‑year survival of ambulatory patients with end‑stage heart failure: the analysis of prognostic factors.
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Szygula-Jurkiewicz B, Szczurek W, Skrzypek M, Zakliczyński M, Siedlecki Ł, Przybyłowski P, Zembala M, Gąsior M,


Szygula-Jurkiewicz B, Szczurek W, Skrzypek M, Zakliczyński M, Siedlecki Ł, Przybyłowski P, Zembala M, Gąsior M, (click to view)

Szygula-Jurkiewicz B, Szczurek W, Skrzypek M, Zakliczyński M, Siedlecki Ł, Przybyłowski P, Zembala M, Gąsior M,

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Polish archives of internal medicine 2017 03 15127(4) 254-260 doi 10.20452/pamw.3975
Abstract

INTRODUCTION    An increasing number of ambulatory patients are placed on orthotopic heart transplantation (OHT) waiting lists, which results in an extended waiting time and a higher mortality rate. OBJECTIVES    The aim of this study was to identify the factors associated with reduced survival during a 1‑year follow‑up in patients with end‑stage heart failure listed for an OHT. PATIENTS AND METHODS    We retrospectively analyzed the data of 221 adult patients, who were accepted for OHT in our institution over a 2‑year period between 2013 and 2014. RESULTS    The mean (SD) age of the patients was 54.7 (9.6) years, and 90.1% of them were male. The mortality rate during the follow‑up period was 43.3%. The modified Model for End‑Stage Liver Disease (modMELD) score (odds ratio [OR], 1.70; P <0.001), as well as the plasma levels of high‑sensitivity C‑reactive protein (hs‑CRP; OR, 1.10; P <0.01), sodium (OR, 0.74; P <0.001), and uric acid (UA; OR, 1.003; P <0.05) were independent factors affecting death. The receiver‑operating characteristic (ROC) analysis indicated that a modMELD cut‑off of 10 (area under the ROC curve [AUC], 0.868; P <0.001), hs‑CRP cut‑off of 5.6 mg/l (AUC, 0.674; P <0.001), plasma sodium level cut‑off of 135 mmol/l (AUC, 0.778; P <0.001), and a plasma UA cut‑off of 488 μmol/l (AUC, 0.634; P <0.001) were the most accurate factors affecting death. CONCLUSIONS    In conclusion, although limited to a single center, our study demonstrated that an elevated modMELD score, incorporating a combination of renal and hepatic laboratory parameters, as well as plasma sodium, UA, and hs‑CRP levels at the time of listing are associated with reduced survival in ambulatory patients with end‑stage heart failure, accepted for OHT.

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