Table 1.
Baseline characteristics of patients hospitalized with ADHF according to tertiles of the De Ritis ratio
| Variables | Total cohort (n = 249) | De Ritis ratio | P | ||
|---|---|---|---|---|---|
| 1st tertile (n = 82) | 2nd tertile (n = 88) | 3rd tertile (n = 79) | |||
| Age, years, Me (IQR) | 78 (70; 85) | 74 (70; 81.2) | 81.5 (73; 89) | 78 (70; 84) | 0.003 |
| Female, n (%) | 134 (53.8) | 42 (51.2) | 53 (60.2) | 39 (49.4) | 0.316 |
| Arterial hypertension, n (%) | 215 (86.3) | 68 (82.9) | 79 (89.8) | 68 (86.1) | 0.429 |
| CAD, n (%) | 157 (63.1) | 47 (57.3) | 57 (64.8) | 53 (67.1) | 0.402 |
| Previous MI, n (%) | 95 (38.2) | 28 (34.1) | 36 (40.9) | 31 (39.2) | 0.644 |
| Dyslipidemia, n (%) | 233 (93.6) | 75 (91.5) | 86 (97.7) | 72 (91.1) | 0.141 |
| Diabetes mellitus, n (%) | 93 (37.3) | 22 (26.8) | 34 (38.6) | 37 (46.8) | 0.031 |
| Previous CVA, n (%) | 57 (22.9) | 13 (15.9) | 24 (27.3) | 20 (25.3) | 0.172 |
| Atrial fibrillation, n (%) | 121 (48.6) | 39 (47.6) | 41 (46.6) | 41 (51.9) | 0.770 |
| CKD, n (%) | 168 (67.5) | 53 (64.6) | 59 (67) | 56 (70.9) | 0.695 |
| Chronic lung disease, n (%) | 27 (10.8) | 10 (12.2) | 7 (8.0) | 10 (12.7) | 0.553 |
| Anemia, n (%) | 130 (52.2) | 40 (48.8) | 45 (51.1) | 45 (57) | 0.565 |
| Chest pain, n (%) | 41 (16.5) | 12 (14.6) | 13 (14.8) | 16 (20.3) | 0.547 |
| Dyspnea, n (%) | 241 (96.8) | 80 (97.6) | 85 (96.6) | 76 (96.2) | 0.880 |
| Peripheral edema, n (%) | 71 (28.5) | 19 (23.2) | 23 (26.1) | 29 (36.7) | 0.136 |
| NYHA class III-IV, n (%) | 137 (55) | 24 (29.3) | 49 (55.7) | 64 (81) | <0.001 |
| Systolic blood pressure, mm Hg, Me (IQR) | 120 (110; 138) | 121.5 (115; 133.7) | 121.5 (110.5; 139.7) | 120 (110; 137) | 0.640 |
| Diastolic blood pressure, mm Hg, Me (IQR) | 70 (61.5; 80) | 70 (63; 80) | 75 (65; 80) | 70 (60; 80) | 0.436 |
| Heart rate, bpm, Me (IQR) | 89 (82; 100.5) | 86.5 (79.7; 100) | 89 (80.5; 102.7) | 92 (82; 105) | 0.313 |
| NT-proBNP, Me (IQR), pg/mL, Me (IQR) | 5,211 (2,887; 10,202) | 2,892 (2,156; 4,668) | 5,367 (3,117; 9,349) | 8,606 (5,639; 17,891) | <0.001 |
| Hemoglobin, g/đL, Me (IQR) | 12.2 (10.5; 13.8) | 12.3 (10.9; 13.8) | 12 (10.3; 13.5) | 12.0 (10.3; 14) | 0.595 |
| Creatinine, μmol/L, Me (IQR) | 110 (88; 134.5) | 107.5 (91; 127) | 114 (84.2; 137.7) | 113 (88; 141) | 0.791 |
| eGFR, mL/min/1.73 m2, Me (IQR) | 48.4 (36.2; 66.8) | 52 (37; 68.8) | 46.4 (32.1; 64.6) | 47.1 (38.2; 66.4) | 0.286 |
| AST, U/L, Me (IQR) | 45 (33; 62.5) | 35.5 (28.7; 49.5) | 45 (34; 66.7) | 55 (41; 79) | <0.001 |
| ALT, U/L, Me (IQR) | 33 (25; 47.5) | 37 (29; 51.2) | 33 (25.2; 50.2) | 32 (23; 44) | 0.012 |
| LVEF, %, Me (IQR) | 40 (28; 53) | 45 (34.2; 60) | 42 (30; 52) | 32 (20; 45) | <0.001 |
| TAPSE, mm, Me (IQR) | 19 (17; 20) | 19 (17; 20) | 19 (17; 20) | 18 (16; 20) | 0.305 |
| IVC, mm, Me (IQR) | 20 (19; 21) | 19 (18.7; 21) | 20 (19; 21.7) | 21 (19; 22) | 0.018 |
| IVC ≥ 21 mm | 100 (40.2) | 22 (26.8) | 36 (40.9) | 42 (53.2) | 0.003 |
| Discharge medications, n (%) | |||||
| Beta-blocker | 111 (44.6) | 45 (54.9) | 34 (38.6) | 32 (40.5) | 0.07 |
| RAAS inhibitor | 194 (77.9) | 65 (79.3) | 66 (75) | 63 (79.7) | 0.713 |
| SGLT2i | 121 (48.6) | 41 (50) | 41 (46.6) | 39 (49.4) | 0.894 |
| MRAs | 131 (52.6) | 48 (58.5) | 40 (45.5) | 43 (54.4) | 0.216 |
| Loop diuretics | 232 (93.2) | 77 (93.9) | 78 (88.6) | 77 (97.5) | 0.074 |
1 ADHF, acute decompensated heart failure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CAD, coronary artery disease; CKD, chronic kidney disease; CVA, cerebrovascular accident; eGFR, estimated glomerular filtration rate; IQR, interquartile range; IVC, inferior vena cava; LVEF, left ventricular ejection fraction; Me, median; MI, myocardial infarction; MRAs, mineralocorticoid receptor antagonists; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; RAAS, Renin-Angiotensin-Aldosterone System; SGLT2i, SodiumGlucose Cotransporter-2 inhibitors; TAPSE, tricuspid annular plane systolic excursion.
Table 2.
One-year MACEs in the study population stratified by tertiles of the De Ritis ratio
| Variables | Total cohort (n = 249) | De Ritis ratio | P | ||
|---|---|---|---|---|---|
| 1st tertile (n = 82) | 2nd tertile (n = 88) | 3rd tertile (n = 79) | |||
| All-cause death | |||||
| In-hospital mortality, n (%) | 15 (6) | 2 (2.4) | 9 (10.2) | 4 (5.1) | 0.094 |
| 1-year mortality, n (%) | 53 (21.3) | 7 (8.5) | 19 (21.6) | 27 (34.2) | <0.001 |
| MACEs | 150 (60.2) | 26 (31.7) | 57 (64.8) | 67 (84.8) | |
| Overall 1-year mortality, n (%) | 68 (27.3) | 9 (11) | 28 (31.8) | 31 (39.2) | <0.001 |
| HF rehospitalization, n (%) | 79 (31.7) | 15 (18.3) | 27 (30.7) | 37 (46.8) | |
| MI, n (%) | 10 (4.0) | 1 (1.2) | 3 (3.4) | 6 (7.6) | |
| Stroke, n (%) | 15 (6.0) | 0 (0) | 11 (12.5) | 4 (5.1) | |
Figure 1.
ROC curve of the De Ritis ratio for predicting 1-year MACEs in elderly patients hospitalized with acute decompensated HF. AUC, area under the curve; CI, confidence interval; HF, heart failure; MACEs, major adverse cardiovascular events; ROC, receiver operating characteristic.
Figure 2.
Kaplan-Meier survival curves for 1-year MACEs stratified by tertiles of the De Ritis ratio. MACEs, major adverse cardiovascular events.
Table 3.
Cox proportional hazards regression analysis for predictors of 1-year MACEs
| Variables | Univariate | Multivariate | ||
|---|---|---|---|---|
| HR (95% CI) | P | HR (95% CI) | P | |
| Age (years) | 1.026 (1.002-1.044) | 0.003 | 1.002 (0.983-1.022) | 0.820 |
| Female | 1.268 (0.918-1.751) | 0.149 | 1.231 (0.859-1.765) | 0.258 |
| Arterial hypertension | 1.185 (0.724-1.939) | 0.500 | 0.967 (0.571-1.638) | 0.901 |
| CAD | 1.930 (1.354-2.751) | <0.001 | 1.221 (0.820-1.819) | 0.326 |
| Atrial fibrillation | 0.868 (0.629-1.197) | 0.387 | 0.850 (0.605-1.194) | 0.349 |
| Diabetes mellitus | 2.941 (2.126-4.068) | <0.001 | 1.480 (1.011-2.167) | 0.044 |
| Chronic lung disease | 1.670 (1.052-2.652) | 0.03 | 1.695 (1.010-2.845) | 0.046 |
| Previous CVA | 2.348 (1.659-3.323) | <0.001 | 1.497 (1.021-2.197) | 0.039 |
| Anemia | 1.286 (0.931-1.775) | 0.127 | 1.154 (0.820-1.624) | 0.412 |
| logNT-proBNP | 11.134 (7.098-17.456) | <0.001 | 3.760 (2.066-6.844) | <0.001 |
| LVEF ≤ 40% | 2.409 (1.726-3.363) | <0.001 | 1.559 (1.057-2.298) | 0.025 |
| eGFR < 60 mL/min/1.73 m2 | 1.572 (1.094-2.259) | 0.014 | 1.010 (0.664-1.538) | 0.961 |
| De Ritis ratio >1.30 | 4.378 (2.962-6.472) | <0.001 | 2.362 (1.536-3.634) | <0.001 |