Abstract 11023: Low Systolic Blood Pressure at Admission Identifies Patients with Decompensated Heart Failure Who Are Undergoing Slow Continuous Ultrafiltration at High Risk of Short Term Mortality
Introduction Slow continuous ultrafiltration (SCUF) has emerged as a new therapeutic modality to improve volume overload and potentially reduce re-hospitalizations in decompensated heart failure patients (ADHF). We recently reported our experience with high morbidity and mortality rates associated with SCUF in patients with ADHF. We sought to examine factors that predict mortality in these patients.
Methods We retrospectively reviewed data (demographics, hemodynamics and medications used prior and after ultrafiltration) from 61 consecutive adult patients admitted from 2004 to 2009 to the Heart failure intensive care unit with diagnoses of ADHF that underwent SCUF for at least 24 hrs.
Results: In our cohort (median age 58 years, 76% male, 59% ischemic cardiomyopathy, 60% hypertension, 60% diabetes mellitus and 48% had prior diagnosis of CKD≥ stage III), 36 (59%) patients were alive at the time of discharge, 19 (31%) died during its admission and 6 (10%) were discharge to hospice. Comparing between patients who were alive within 30 days of discharge, the patients that died within 30 days were more likely to have pre-existing ≥ Stage III CKD (28% vs 8%,p=0.05), lower systolic blood pressure (113±15 vs 99±25 mmHg,p=0.0019) and diastolic blood pressure at admission (64±10 vs 57±13 mmHg,p=0.02) with need for inotropic therapy prior to SCUF (28% vs 58%,p=0.017), despite similar clinical and hemodynamic profiles. Prior to SCUF, those patients were more hyponatremic (132±6 vs 129±8 mmol/L,p=0.017), more hyperkalemic (4.6±0.4 vs 4.3 ±0.4 mmol/L,p=0.0160 and had higher serum creatinine levels (2.8 ±0.9 vs 2.2 ±1.0,p=0.03). After 48 hours on SCUF, they persisted with lower systolic blood pressure (97±16 vs 106±13 mmHg,p=0.03) despite similar hemodynamic measurements. In the multivariate analysis, admission systolic blood pressure was the single most important independent factor associated with mortality (adjusted OR 0.96, 95% CI 0.91-0.99,p=0.02).
Conclusion: Low systolic blood pressure at admission identifies patients with decompensated heart failure that undergo SCUF at high risk of short-term mortality. These findings highlight the importance of contractile reserve to maintain adequate perfusion in the setting of mechanical salt and water removal.
- © 2011 by American Heart Association, Inc.