Integrating Clinical, Hematologic, and Electrocardiographic Markers for Early Prediction of In-Hospital Mortality and Functional Decline in Acute Decompensated Heart Failure: A Multivariate Analysis

Background. Acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF) remains a critical cause of hospitalization, characterized by high short-term mortality and significant functional impairment. Early identification of patients at risk using readily available clinical parameters is essential for optimizing management and improving outcomes. Objectives. This study aimed to identify independent clinical, laboratory, and electrocardiographic predictors of in-hospital mortality and severe functional limitation, as defined by New York Heart Association (NYHA) class IV, in patients admitted with ADHF. Methods. In this retrospective cross-sectional study, 100 patients hospitalized with HFrEF were evaluated. Demographic data, comorbidities, clinical signs, laboratory biomarkers, and ECG parameters were analyzed. Multivariate logistic regression models were employed to determine independent predictors of in-hospital mortality and NYHA class IV status. Results. The in-hospital mortality rate was 16%, and 45% of patients were classified as NYHA class IV prior to admission. Multivariate analysis identified female sex (OR: 8.11; p = 0.023), elevated jugular venous pressure (OR: 12.40; p = 0.025), anemia (OR: 9.11; p = 0.034), prolonged QTc interval (OR: 1.03 per ms; p = 0.029), increased heart rate (OR: 1.04 per bpm; p = 0.048), and leukocytosis (OR: 1.46; p = 0.025) as independent predictors of in-hospital mortality. Severe functional impairment (NYHA class IV) was independently associated with pulmonary rales/wheezing/rhonchi (OR: 4.40; p = 0.026), tricuspid or mitral valve murmurs (OR: 3.26; p = 0.020), and reduced serum alkaline phosphatase levels (OR: 0.994; p = 0.014). Conclusion. Simple, bedside-accessible clinical and paraclinical markers—including JVP elevation, QTc prolongation, anemia, leukocytosis, and pulmonary auscultation findings—serve as robust predictors of early mortality and functional decline in ADHF. These findings advocate for the integration of routine clinical assessments and basic investigations into early risk stratification frameworks to enhance acute heart failure management, particularly in resource-limited settings.