J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 3, March 2017, pages 200-206

The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure

Figure 2. Kaplan-Meier curves of survival in quartiles (lowest, second, third and highest) according to ΔBWI.

**Table 1.** Patient Characteristics in the Survival and Death Groups
	Survival group (n = 116)	Death group (n = 14)	Survival vs. death P value
DM: diabetes mellitus; HTN: hypertension; SBP: systolic blood pressure; NYHA: New York Heart Association; HF: heart failure; IHD: ischemic heart disease; HTCM: hypertensive cardiomyopathy; DCM: dilated cardiomyopathy; ICD: implantable cardioverter defibrillator; LVEF: left ventricular ejection fraction; ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin II type 1 receptor blocker; BNP: brain natriuretic peptide; Na: sodium; BUN: blood urea nitrogen; Hb: hemoglobin; CCr: creatinine clearance; SFA: surface area; BW: body weight; BMI: body mass index; ΔBWI: changes in body weight index; Q: quartile.
Age, years	67 ± 10	81 ± 5	0.0007
Male, n (%)	72 (62)	7 (50)	0.38
DM, n (%)	26 (22)	8 (43)	0.09
HTN, n (%)	69 (59)	7 (50)	0.53
SBP, mm Hg	127 ± 19	119 ± 18	0.03
NYHA functional class
II, n (%)	23 (19)	2 (14)	0.61
III, n (%)	25 (22)	6 (42)	0.08
IV, n (%)	65 (56)	6 (42)	0.34
The cause of HF
IHD, n (%)	34 (29)	3 (21)	0.53
HTCM, n (%)	11 (9)	1 (7)	0.77
Valvular disease, n (%)	22 (18)	3 (21)	0.82
DCM, n (%)	21 (18)	5 (35)	0.11
Arrythmia, n (%)	13 (11)	1 (7)	0.64
Unknown, n (%)	15 (12)	1 (7)	0.53
ICD, n (%)	16 (13)	6 (42)	0.006
LVEF, %	43 ± 18	39 ± 16	0.38
Medications
Diuretics, n (%)	92 (79)	13 (92)	0.22
ACEI/ARB, n (%)	87 (75)	8 (57)	0.15
Digitalis, n (%)	11 (9)	2 (14)	0.57
Oral anticoagulant, n (%)	56 (48)	7 (50)	0.90
Nitrates, n (%)	11 (9)	2 (14)	0.57
Spironolactone, n (%)	68 (58)	9 (64)	0.68
β-blockers, n (%)	70 (60)	8 (57)	0.81
Antiplatelets, n (%)	61 (52)	5 (35)	0.23
Laboratory test
BNP, pg/mL	370.0 ± 274.2	842.5 ± 292.5	0.006
Na, mEq/L	141.0 ± 2.0	137.0 ± 2.0	0.001
BUN, mg/dL	18.0 ± 4.0	37.5 ± 12.5	0.00003
Hb, g/dL	13.5 ± 2.5	11.6 ± 1.4	0.008
CCr, ml/min	54.9 ± 17.4	26.5 ± 7.1	0.00002
Duration of hospitalization, days	21.0 ± 8.5	36.0 ± 16.5	0.01
SFA at discharge, m²	1.57 ± 0.19	1.48 ± 0.22	0.12
BW at hospitalization, kg	61.0 ± 8.9	52.5 ± 12.6	0.13
BW at discharge, kg	54.9 ± 8.3	48.3 ± 8.6	0.19
BMI at admission, kg/m²	23.9 ± 2.4	23.2 ± 3.2	0.59
BMI at discharge, kg/m²	21.8 ± 2.2	21.1 ± 1.8	0.89
ΔBWI, kg/m²	3.18 ± 1.69	2.14 ± 1.42	0.13
Lowest Q, n (%)	26 (22)	6 (42)	0.09
Second Q, n (%)	29 (25)	4 (28)	0.77
Third Q, n (%)	31 (26)	1 (7)	0.10
Highest Q, n (%)	30 (25)	3 (21)	0.71

Table 1. Patient Characteristics in the Survival and Death Groups

Survival group (n = 116)

Death group (n = 14)

Survival vs. death P value

DM: diabetes mellitus; HTN: hypertension; SBP: systolic blood pressure; NYHA: New York Heart Association; HF: heart failure; IHD: ischemic heart disease; HTCM: hypertensive cardiomyopathy; DCM: dilated cardiomyopathy; ICD: implantable cardioverter defibrillator; LVEF: left ventricular ejection fraction; ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin II type 1 receptor blocker; BNP: brain natriuretic peptide; Na: sodium; BUN: blood urea nitrogen; Hb: hemoglobin; CCr: creatinine clearance; SFA: surface area; BW: body weight; BMI: body mass index; ΔBWI: changes in body weight index; Q: quartile.

Age, years

67 ± 10

81 ± 5

0.0007

Male, n (%)

72 (62)

7 (50)

0.38

DM, n (%)

26 (22)

8 (43)

0.09

HTN, n (%)

69 (59)

7 (50)

0.53

SBP, mm Hg

127 ± 19

119 ± 18

0.03

NYHA functional class

II, n (%)

23 (19)

2 (14)

0.61

III, n (%)

25 (22)

6 (42)

0.08

IV, n (%)

65 (56)

6 (42)

0.34

The cause of HF

IHD, n (%)

34 (29)

3 (21)

0.53

HTCM, n (%)

11 (9)

1 (7)

0.77

Valvular disease, n (%)

22 (18)

3 (21)

0.82

DCM, n (%)

21 (18)

5 (35)

0.11

Arrythmia, n (%)

13 (11)

1 (7)

0.64

Unknown, n (%)

15 (12)

1 (7)

0.53

ICD, n (%)

16 (13)

6 (42)

0.006

LVEF, %

43 ± 18

39 ± 16

0.38

Medications

Diuretics, n (%)

92 (79)

13 (92)

0.22

ACEI/ARB, n (%)

87 (75)

8 (57)

0.15

Digitalis, n (%)

11 (9)

2 (14)

0.57

Oral anticoagulant, n (%)

56 (48)

7 (50)

0.90

Nitrates, n (%)

11 (9)

2 (14)

0.57

Spironolactone, n (%)

68 (58)

9 (64)

0.68

β-blockers, n (%)

70 (60)

8 (57)

0.81

Antiplatelets, n (%)

61 (52)

5 (35)

0.23

Laboratory test

BNP, pg/mL

370.0 ± 274.2

842.5 ± 292.5

0.006

Na, mEq/L

141.0 ± 2.0

137.0 ± 2.0

0.001

BUN, mg/dL

18.0 ± 4.0

37.5 ± 12.5

0.00003

Hb, g/dL

13.5 ± 2.5

11.6 ± 1.4

0.008

CCr, ml/min

54.9 ± 17.4

26.5 ± 7.1

0.00002

Duration of hospitalization, days

21.0 ± 8.5

36.0 ± 16.5

0.01

SFA at discharge, m²

1.57 ± 0.19

1.48 ± 0.22

0.12

BW at hospitalization, kg

61.0 ± 8.9

52.5 ± 12.6

0.13

BW at discharge, kg

54.9 ± 8.3

48.3 ± 8.6

0.19

BMI at admission, kg/m²

23.9 ± 2.4

23.2 ± 3.2

0.59

BMI at discharge, kg/m²

21.8 ± 2.2

21.1 ± 1.8

0.89

ΔBWI, kg/m²

3.18 ± 1.69

2.14 ± 1.42

0.13

Lowest Q, n (%)

26 (22)

6 (42)

0.09

Second Q, n (%)

29 (25)

4 (28)

0.77

Third Q, n (%)

31 (26)

1 (7)

0.10

Highest Q, n (%)

30 (25)

3 (21)

0.71

**Table 2.** Patient Characteristics in Quartiles According to ΔBWI
	Lowest Q (n = 32)	Second Q (n = 33)	Third Q (n = 32)	Highest Q (n = 33)	P value
ΔBWI: changes in body weight index; Q: quartile; DM: diabetes mellitus; HYN; hypertension; SBP: systolic blood pressure; NYHA: New York Heart Association; HF; heart failure; IHD: ischemic heart disease; HTCM: hypertensive cardiomyopathy; DCM: dilated cardiomyopathy; ICD: implantable cardioverter defibrillator; LVEF: left ventricular ejection fraction; ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin II type 1 receptor blocker; BNP: brain natriuretic peptide; Na: sodium; BUN: blood urea nitrogen; Hb: hemoglobin; BW: body weight; BMI: body mass index; CCr: creatinine clearance; SFA: surface area.
Age, years	74 ± 9	65 ± 11	68 ± 7	63 ± 10	0.008
Male, n (%)	15 (47)	16 (49)	22 (69)	26 (79)	0.02
DM	8 (25)	13 (39)	5 (15)	6 (18)	0.11
HTN	24 (75)	19 (57)	17 (53)	15 (45)	0.10
SBP, mm Hg	124.5 ± 10.0	122.0 ± 22.9	130.0 ± 15.0	124.0 ± 28.5	0.83
NYHA functional class
II, n (%)	9 (28)	8 (24)	7 (21)	1 (3)	0.048
III, n (%)	13 (40)	7 (21)	7 (21)	4 (12)	0.05
IV, n (%)	9 (28)	18 (54)	16 (50)	28 (84)	<0.0001
The cause of HF
IHD, n (%)	7 (21)	7 (21)	9 (28)	14 (42)	0.19
HTCM, n (%)	3 (9)	2 (6)	3 (9)	4 (12)	0.86
Valvular disease, n (%)	9 (28)	7 (21)	7 (21)	2 (6)	0.13
DCM, n (%)	4 (12)	8 (24)	6 (18)	8 (24)	0.59
Arrythmia, n (%)	6 (18)	4 (12)	2 (6)	2 (6)	0.30
Unknown, n (%)	3 (9)	5 (15)	5 (15)	3 (9)	0.77
ICD, n (%)	3 (9)	8 (24)	5 (15)	6 (18)	0.45
LVEF, %	51 ± 18	42 ± 17	42 ± 19	36 ± 13	0.01
Medications
Diuretics, n (%)	24 (75)	26 (78)	26 (81)	29 (87)	0.60
ACEI/ARB, n (%)	25 (78)	24 (72)	27 (84)	19 (57)	0.09
Digitalis, n (%)	0 (0)	5 (15)	2 (6)	6 (18)	0.06
Oral anticoagulant, n (%)	15 (46)	17 (51)	17 (53)	14 (42)	0.82
Nitrates, n (%)	4 (12)	4 (12)	4 (12)	1 (3)	0.49
Spironolactone, n (%)	15 (46)	22 (66)	21 (65)	19 (57)	0.33
β-blockers, n (%)	23 (71)	14 (42)	22 (68)	19 (57)	0.06
Antiplatelets, n (%)	17 (53)	15 (45)	14 (43)	20 (60)	0.50
Laboratory test
BNP, pg/mL	262.5 ± 267.7	473.0 ± 333.3	370.0 ± 190.2	588.0 ± 533.2	0.10
Na, mEq/L	140.0 ± 2.0	141.0 ± 2.6	140.0 ± 2.0	141.0 ± 1.5	0.17
BUN, mg/dL	19.5 ± 4.3	19.0 ± 6.0	17.0 ± 4.8	19.0 ± 5.1	0.88
Hb, g/dL	12.5 ± 2.4	13.5 ± 2.4	13.1 ± 2.8	14.0 ± 2.2	0.08
BW at admission, kg	55.3 ± 8.3	58.7 ± 9.8	58.5 ± 8.6	65.0 ± 8.5	0.03
BW at discharge, kg	54.6 ± 8.7	55.9 ± 9.5	53.3 ± 8.3	53.4 ± 7.2	0.78
BMI at admission, kg/m²	22.8 ± 2.5	24.3 ± 2.6	24.0 ± 2.3	24.9 ± 2.1	0.14
BMI at discharge, kg/m²	22.5 ± 2.4	22.6 ± 2.4	21.4 ± 2.3	20.8 ± 2.0	0.07
Duration of hospitalization, days	18.5 ± 7.0	20.0 ± 8.3	23.5 ± 9.8	28.0 ± 11.8	0.006
CCr, mL/min	46.4 ± 18.5	63.0 ± 21.0	53.5 ± 19.6	52.9 ± 15.5	0.09
SFA at discharge, m²	1.52 ± 0.21	1.59 ± 0.20	1.54 ± 0.17	1.58 ± 0.19	0.45
Two-year mortality rates, n (%)	6 (18)	4 (12)	1 (3)	3 (9)	0.23

Table 2. Patient Characteristics in Quartiles According to ΔBWI

Lowest Q (n = 32)

Second Q (n = 33)

Third Q (n = 32)

Highest Q (n = 33)

P value

ΔBWI: changes in body weight index; Q: quartile; DM: diabetes mellitus; HYN; hypertension; SBP: systolic blood pressure; NYHA: New York Heart Association; HF; heart failure; IHD: ischemic heart disease; HTCM: hypertensive cardiomyopathy; DCM: dilated cardiomyopathy; ICD: implantable cardioverter defibrillator; LVEF: left ventricular ejection fraction; ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin II type 1 receptor blocker; BNP: brain natriuretic peptide; Na: sodium; BUN: blood urea nitrogen; Hb: hemoglobin; BW: body weight; BMI: body mass index; CCr: creatinine clearance; SFA: surface area.

Age, years

74 ± 9

65 ± 11

68 ± 7

63 ± 10

0.008

Male, n (%)

15 (47)

16 (49)

22 (69)

26 (79)

0.02

8 (25)

13 (39)

5 (15)

6 (18)

0.11

HTN

24 (75)

19 (57)

17 (53)

15 (45)

0.10

SBP, mm Hg

124.5 ± 10.0

122.0 ± 22.9

130.0 ± 15.0

124.0 ± 28.5

0.83

NYHA functional class

II, n (%)

9 (28)

8 (24)

7 (21)

1 (3)

0.048

III, n (%)

13 (40)

7 (21)

4 (12)

0.05

IV, n (%)

9 (28)

18 (54)

16 (50)

28 (84)

<0.0001

The cause of HF

IHD, n (%)

7 (21)

9 (28)

14 (42)

0.19

HTCM, n (%)

3 (9)

2 (6)

3 (9)

4 (12)

0.86

Valvular disease, n (%)

9 (28)

7 (21)

2 (6)

0.13

DCM, n (%)

4 (12)

8 (24)

6 (18)

8 (24)

0.59

Arrythmia, n (%)

6 (18)

4 (12)

2 (6)

0.30

Unknown, n (%)

3 (9)

5 (15)

3 (9)

0.77

ICD, n (%)

3 (9)

8 (24)

5 (15)

6 (18)

0.45

LVEF, %

51 ± 18

42 ± 17

42 ± 19

36 ± 13

0.01

Medications

Diuretics, n (%)

24 (75)

26 (78)

26 (81)

29 (87)

0.60

ACEI/ARB, n (%)

25 (78)

24 (72)

27 (84)

19 (57)

0.09

Digitalis, n (%)

0 (0)

5 (15)

2 (6)

6 (18)

0.06

Oral anticoagulant, n (%)

15 (46)

17 (51)

17 (53)

14 (42)

0.82

Nitrates, n (%)

4 (12)

1 (3)

0.49

Spironolactone, n (%)

15 (46)

22 (66)

21 (65)

19 (57)

0.33

β-blockers, n (%)

23 (71)

14 (42)

22 (68)

19 (57)

0.06

Antiplatelets, n (%)

17 (53)

15 (45)

14 (43)

20 (60)

0.50

Laboratory test

BNP, pg/mL

262.5 ± 267.7

473.0 ± 333.3

370.0 ± 190.2

588.0 ± 533.2

0.10

Na, mEq/L

140.0 ± 2.0

141.0 ± 2.6

140.0 ± 2.0

141.0 ± 1.5

0.17

BUN, mg/dL

19.5 ± 4.3

19.0 ± 6.0

17.0 ± 4.8

19.0 ± 5.1

0.88

Hb, g/dL

12.5 ± 2.4

13.5 ± 2.4

13.1 ± 2.8

14.0 ± 2.2

0.08

BW at admission, kg

55.3 ± 8.3

58.7 ± 9.8

58.5 ± 8.6

65.0 ± 8.5

0.03

BW at discharge, kg

54.6 ± 8.7

55.9 ± 9.5

53.3 ± 8.3

53.4 ± 7.2

0.78

BMI at admission, kg/m²

22.8 ± 2.5

24.3 ± 2.6

24.0 ± 2.3

24.9 ± 2.1

0.14

BMI at discharge, kg/m²

22.5 ± 2.4

22.6 ± 2.4

21.4 ± 2.3

20.8 ± 2.0

0.07

Duration of hospitalization, days

18.5 ± 7.0

20.0 ± 8.3

23.5 ± 9.8

28.0 ± 11.8

0.006

CCr, mL/min

46.4 ± 18.5

63.0 ± 21.0

53.5 ± 19.6

52.9 ± 15.5

0.09

SFA at discharge, m²

1.52 ± 0.21

1.59 ± 0.20

1.54 ± 0.17

1.58 ± 0.19

0.45

Two-year mortality rates, n (%)

6 (18)

4 (12)

1 (3)

3 (9)

0.23

**Table 3.** Cox Proportional Hazards Analyses to Identify Independent Predictors of Mortality
	β	z value	P value
DM: diabetes mellitus; CCr: creatinine clearance; ΔBWI: changes in body weight index; HTCM: hypertensive cardiomyopathy; BNP: brain natriuretic peptide; SBP: systolic blood pressure.
DM	2.51	3.05	0.0023
Duration of hospitalization	0.99	3.38	0.0007
CCr	-1.01	3.7	0.0002
ΔBWI	-3.53	3.72	0.0002
β-blockers	-3.66	2.97	0.0029
HTCM	5.53	3.06	0.0022
BNP	0.52	3.44	0.0006
SBP	-1.29	3.67	0.0002

Table 3. Cox Proportional Hazards Analyses to Identify Independent Predictors of Mortality

z value

P value

DM: diabetes mellitus; CCr: creatinine clearance; ΔBWI: changes in body weight index; HTCM: hypertensive cardiomyopathy; BNP: brain natriuretic peptide; SBP: systolic blood pressure.

2.51

3.05

0.0023

Duration of hospitalization

0.99

3.38

0.0007

CCr

-1.01

3.7

0.0002

ΔBWI

-3.53

3.72

0.0002

β-blockers

-3.66

2.97

0.0029

HTCM

5.53

3.06

0.0022

BNP

0.52

3.44

0.0006

SBP

-1.29

3.67

0.0002

**Table 4.** A Multivariate Cox Proportional Hazards Analysis Combined With Categorized ΔBWI
	β	z value	P value	RR (95% CI)
ΔBWI: changes in body weight index; Q: quartile; RR: relative risk; CI: confidence interval
ΔBWI
Lowest Q	2	1.99	0.04	7.46 (1.03 - 53.99)
Second Q	1.39	1.6	0.1	4.02 (0.73 - 22.04)
Third Q	-0.1	0.08	0.93	0.89 (0.07 - 11.16)
Highest Q				1.00

Table 4. A Multivariate Cox Proportional Hazards Analysis Combined With Categorized ΔBWI

z value

P value

RR (95% CI)

ΔBWI: changes in body weight index; Q: quartile; RR: relative risk; CI: confidence interval

ΔBWI

Lowest Q

1.99

0.04

7.46 (1.03 - 53.99)

Second Q

1.39

1.6

0.1

4.02 (0.73 - 22.04)

Third Q

-0.1

0.08

0.93

0.89 (0.07 - 11.16)

Highest Q

1.00