SPC365

Urea Levels at Admission: A Forgotten Yet Crucial Prognostic Marker in Hospitalized Heart Failure Patients

Session: Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker: Simão Pedro Almeida Carvalho

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Simão De Almeida Carvalho; Carlos Costa; Adriana Pacheco; Tiago Aguiar; Diana Carvalho; Andreia Fernandes; Mesquita Bastos; Ana Briosa

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Heart failure represents a significant health concern marked by heightened morbidity and mortality, with each hospital admission posing potential risks for adverse outcomes. Identifying predictors of these outcomes holds vital importance, shaping healthcare decisions regarding hospitalization necessity and optimal care. Renal function intricately intertwines with the cardiovascular system, influencing cardiac function. Elevated urea levels often manifest in contexts linked to heart failure decompensation, reflecting impaired renal function and heightened cardiac stress.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Evaluate the prognostic significance of urea levels upon admission in hospitalized patients experiencing decompensated heart failure.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A single-center cross-sectional study comprised 619 hospitalized patients experiencing decompensated heart failure. Statistical analyses, including Independent-Samples T Test, Chi-square, and Kaplan-Meier analysis, were performed using SPSS software. A ROC&nbsp;analysis was conducted to classify groups based on a urea cutoff for the 1-year composite endpoint. This composite endpoint encompassed readmission, return visits to the Emergency Department attributable to heart failure, and mortality.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 619 patients were evaluated, with a mean age of 79.4 years, and 40.9% were female. The average length of hospital stay was 4.1 days. The mean Nt-proBNP at admission was 8651 pg/mL. Among the patients, 45.2% had heart failure with reduced ejection fraction, with a mean left ventricular ejection fraction of 43.1%. The average follow-up time was 244.5 days. ROC analysis demonstrated the highest accuracy for the 1-year composite endpoint with a Urea cutoff of approximately 80 mg/dL.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Patients above the 80 mg/dL urea cutoff exhibited higher creatinine (1.3 vs. 1.0 mg/dL), lower systolic/diastolic blood pressure at admission (129.4/68.2 vs. 138.7/75.4 mmHg), and elevated NT-proBNP (13053 vs. 5975). While LVEF was similar, Systolic Pulmonary Artery Pressure (SPAP) was higher (53.3 vs. 46.0 mmHg). Elevated urea levels consistently correlated with higher risk across intra-hospital mortality, 30-day, 1-year, and total follow-up analyses.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Kaplan-Meier analysis for the composite endpoint revealed a significant difference (p&lt;0.001), indicating shorter time-to-event in patients with higher admission urea levels.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The findings suggest a strong link between elevated urea levels and adverse clinical indicators (blood pressure, NT-proBNP, SPAP), consistently associated with worse outcomes across different follow-up durations. Patients with elevated urea levels experienced faster occurrence of the composite primary endpoint. Further validation of the cutoff&#39;s clinical relevance is warranted, yet the initial urea measurement shows promise in predicting prognosis for hospitalized Heart Failure patients.</span></span></span></p>