Common laboratory parameters as indicators of multi-organ dysfunction in acute heart failure.
Peter McCullough M.D.
Sudhakaran, S. and P. A. McCullough (2019). “Common laboratory parameters as indicators of multi-organ dysfunction in acute heart failure.” Eur J Heart Fail Apr 11. [Epub ahead of print].
Understanding of diagnosis, classification, pathophysiology, prognosis, and treatment of heart failure remains of major interest in clinical cardiology. There are approximately 23 million people with heart failure worldwide, and that estimate is expected to increase by roughly 772 000 by the year 2040. Patients on average have a 5‐year mortality of 50% after the diagnosis is established, most commonly in the setting of hospitalization for acute heart failure (AHF), and clinically, prognostication when admitted to the inpatient setting is challenging. In this issue of the Journal, the retrospective analysis by Zymliński et al.demonstrates how multi‐organ dysfunction as reflected by commonly measured laboratory parameters impacts AHF outcomes. The authors evaluated worsening heart failure and 1‐year mortality in AHF stratified by laboratory evidence of concomitant multi‐organ failure (namely cardiac, kidney, and liver injury/dysfunction) . . . The data presented by Zymliński et al. incites numerous areas of future direction that warrant further investigation. The sample size was small at 284 for multiple comparisons, and thus, it would be beneficial to validate these findings in a larger, prospective cohort. Finally, utilizing these data to delineate a scoring system for prognostication and to assess disease acuity, similar to Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) or Sequential Organ Failure Assessment (SOFA), but tailored specifically for AHF, would be a practical tool for those involved in the care of patients with AHF. (Excerpts from text, p. 1, 2; no abstract available; commenting on a study in the same issue, Zymliński R, et al., Multi‐organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome; no abstract available.)