Risk stratification of mortality in patients with acute decompensated heart failure: a prospective cohort study, Стратификация риска летального исхода у пациентов с острой декомпенсацией хронической сердечной недостаточности, госпитализированных в отделение реанимации: проспективное когортное исследование

<jats:p>INTRODUCTION: Acute decompensated heart failure (ADHF) holds a special place in the structure of acute heart failure, accounting for up to 50 % of emergency hospitalizations in cardiology hospitals. Its clinical significance is determined by high readmission rates: over 50 % within six months, nearly 70 % in the first year, and up to 80 % within two years after an ADHF episode. With an in-hospital mortality rate of about 5 %, the risk of a fatal outcome increases significantly in the long term, reaching 30 % or more within the first year after discharge. Given the increasing prevalence of chronic heart failure in the Russian Federation (8.2 %), development of tools for effective outcome prediction in this patient category is an important clinical task. OBJECTIVE: To develop a model for stratifying the risk of mortality in patients with ADHF hospitalized in the intensive care unit. MATERIALS AND METHODS: A pilot prospective single-center cohort study of 140 patients with ADHF was conducted. A comprehensive analysis of clinical, anamnestic, laboratory, and instrumental parameters was performed using multivariate logistic regression and ROC analysis (receiver operating characteristic). RESULTS: The overall mortality in the cohort was 15.7 %. A prognostic model (nomogram) with good discriminatory ability (area under ROC 0.80; 95% CI 0.66–0.94) was created, including three independent predictors: systolic blood pressure &lt; 100 mm Hg (OR 9.96), D-dimer level ≥ 785 ng/ml (OR 4.90), and International normalized ratio ≥ 1.39 (OR 5.88). At an optimal cutoff of 13 points, the model demonstrates sensitivity and specificity of 77 % each. CONCLUSIONS: A model based on three easily determined parameters has been developed, which allows for the stratification of the risk of mortality in patients with ADHF in intensive care unit, potentially contributing to the optimization of treatment strategies and resource allocation.</jats:p>