4942Serum cholinesterase level provides the additional long-time prognostic information to AHEAD risk score in patients with acute decompensated heart failure

Abstract

Background: In heart failure patients, comorbidities strongly influence the prog-nosis. AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score based on age and comorbidities has been reported as useful long-term risk stratification score in acute decompensated heart failure (ADHF) patients. Malnutrition, which is not included in AHEAD score, is associated with poor outcome in heart failure patients. Serum cholinesterase (CHE), one of the markers of malnutrition, was reported to be a prognostic factor in patients with chronic heart failure. We aimed to investigate whether serum cholinesterase level provides the additional long-time prognostic information to AHEAD risk score in patients with ADHF. Methods and results: We studied 394 patients admitted for ADHF with survival discharge in our prospective cohort study. Laboratory data including CHE was obtained at discharge in all patients. We evaluated AHEAD risk score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 |xmol/L, and diabetes mellitus). The endpoint of this study is the composite of worsening heart failure readmission and cardiac death (cardiac event). During a follow up period of 2.1±1.4 years, 146 patients had cardiac events. At multivariate Cox analysis, CHE (p=0.01), AHEAD risk score (p=0.0006) were significantly associated with cardiac event, independently of prior history of heart failure hospitalization after adjustment of BMI, serum albu-min, sodium, chloride, blood urea nitrogen, uric acid level and plasma BNP level Kaplan-Meier analysis in the subgroup with high AHEAD risk score (defined as 4-5 point) revealed that cardiac event was significantly more frequently observed in patients with low CHE (< 178 determined by ROC analysis: AUC 0.592 [0.487-0.690]) (67% vs 49% p=0.004). Furthermore, in the subgroup with intermediate AHEAD risk score (2-3 point), the incidence of cardiac event was also significantly higher in patients with low CHE (<170 determined by ROC analysis: AUC 0.618 [0.549-0.683]) (58% vs 31% p=0.0002). Finally, in the subgroup with low AHEAD risk score (0-1 point), the incidence of cardiac event was also significantly higher in patients with than in those without low CHE (<255 determined by ROC analysis: AUC 0.607 [0.492-0.714]) (29% vs 13%p=0.03). [Table Presented] Conclusion: Serum cholinesterase level provides the additional long-time prognostic information to AHEAD risk score in patients with acute decompensated heart failure.