Modifiable Predictors of In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.

Autor:	Akinseye OA; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Shahreyar M; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Nwagbara CC; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Nayyar M; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Salem SA; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Morsy M; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Khouzam RN; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee., Ibebuogu UN; Department of Medicine, University of Tennessee Health Science, Memphis, Tennessee. Electronic address: ibebuogu@gmail.com.
Jazyk:	angličtina
Zdroj:	The American journal of the medical sciences [Am J Med Sci] 2018 Aug; Vol. 356 (2), pp. 135-140. Date of Electronic Publication: 2018 Apr 12.
DOI:	10.1016/j.amjms.2018.04.008
Abstrakt:	Background: Transcatheter aortic valve replacement (TAVR) has become an acceptable therapy for patients with severe aortic valve stenosis at high or prohibitive surgical risk. Attempts are ongoing to validate risk prediction models for in-hospital mortality after TAVR. Our aim was to define modifiable risk factors predictive of in-hospital mortality after TAVR. Methods: We identified patients who underwent TAVR from the 2012 database of the National Inpatient Sample. Patients who died during the index hospitalization were compared to those that were successfully discharged. The predictors of in-hospital mortality were analyzed using multivariate logistic regression. Results: A total of 1,360 patients (mean age 81 ± 8.8 years, whites 80.1%, blacks 3.5%) had TAVR and 68 (5%) died during hospitalization (χ 2 [1, n = 1,360] = 1,101.6, P < 0.001). The average length of hospital stay was 8.33 ± 6.7 days. The positive predictors of in-hospital mortality in the unadjusted model were comorbidities such as congestive heart failure, coagulopathy, fluid and electrolyte disorder, weight loss and history of drug abuse. Hypertension was a negative predictor of in-hospital mortality. Following multivariate analysis and adjustment for possible confounders, fluid and electrolyte disorder was the only significant positive predictor of in-hospital mortality (odds ratio = 1.89, CI: 1.11-3.22, P = 0.019). The odds of in-hospital mortality were reduced in patients with hypertension (odds ratio = 0.45, CI: 0.26-0.78, P = 0.004). Conclusions: Fluid and electrolyte disturbance could be a modifiable predictor of in-hospital mortality following TAVR. Efforts should be geared towards reducing its occurrence in this patient population. (Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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