{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:39:24Z","timestamp":1786977564545,"version":"build-2736575974"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":546,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T00:00:00Z","timestamp":1713312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","award":["2019_A142"],"award-info":[{"award-number":["2019_A142"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","award":["2019_A142"],"award-info":[{"award-number":["2019_A142"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Acute heart failure (AHF) can result in worsening of heart failure (WHF), cardiogenic shock (CS), or death. Risk factors for these adverse outcomes are not well characterized. This study aimed to identify predictors for WHF or new-onset CS in patients hospitalized for AHF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Prospective cohort study enrolling consecutive patients with AHF admitted to a large tertiary care centre with follow-up until death or discharge. WHF was defined by the RELAX-AHF-2 criteria. CS was defined as SCAI stages B\u2013E. Potential predictors were assessed by fitting logistic regression models adjusted for age and sex. N = 233 patients were enrolled, median age was 78 years, and 80 were women (35.9%). Ischaemic cardiomyopathy was present in 82 patients (40.8%). Overall, 96 (44.2%) developed WHF and 18 (9.7%) CS. In-hospital death (8\/223, 3.6%) was related to both events (WHF: OR 6.64, 95% CI 1.21\u201336.55, P = 0.03; CS: OR 38.27, 95% CI 6.32\u2013231.81, P &amp;lt; 0.001). Chronic kidney disease (OR 2.20, 95% CI 1.25\u20133.93, P = 0.007), logarithmized serum creatinine (OR 2.90, 95% CI 1.51\u20135.82, P = 0.002), cystatin c (OR 1.86, 95% CI 1.27\u20132.77, P = 0.002), tricuspid valve regurgitation (OR 2.08, 95% CI 1.11\u20133.94, P = 0.023) and logarithmized pro-adrenomedullin (OR 3.01, 95% CI 1.75\u20135.38, P &amp;lt; 0.001) were significant predictors of WHF. Chronic kidney disease (OR 3.17, 95% CI 1.16\u20139.58, P = 0.03), cystatin c (OR 1.88, 95% CI 1.00\u20133.53, P = 0.045), logarithmized pro-adrenomedullin (OR 2.90, 95% CI 1.19\u20137.19, P = 0.019), and tricuspid valve regurgitation (OR 10.44, 95% CI 2.61\u201370.00, P = 0.003) were significantly with new-onset CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Half of patients admitted with AHF experience WHF or new-onset CS. Chronic kidney disease, tricuspid valve regurgitation, and elevated pro-adrenomedullin concentrations predict these events. They could potentially serve as early warning signs for further deterioration in AHF patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14792","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T01:03:46Z","timestamp":1713402226000},"page":"2249-2258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prediction of Cardiac Worsening Through to Cardiogenic Shock in Patients with Acute Heart Failure"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4315-2533","authenticated-orcid":false,"given":"Benedikt N.","family":"Beer","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Kellner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"Center for Population Health Innovation (POINT), University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Sundermeyer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Besch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Dettling","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]},{"name":"Institute of Cardiovascular Sciences, University of Birmingham , Birmingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]},{"name":"Center for Population Health Innovation (POINT), University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Magnussen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]},{"name":"Center for Population Health Innovation (POINT), University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Schrage","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,4,17]]},"reference":[{"key":"2026012113140918500_ehf214792-bib-0001","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026012113140918500_ehf214792-bib-0002","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1002\/ehf2.12555","article-title":"Highlights in heart failure","volume":"6","author":"Tomasoni","year":"2019","journal-title":"ESC Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0003","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s11897-017-0351-y","article-title":"Acute heart failure: definition, classification and epidemiology","volume":"14","author":"Kurmani","year":"2017","journal-title":"Curr Heart Fail Rep"},{"key":"2026012113140918500_ehf214792-bib-0004","doi-asserted-by":"publisher","first-page":"2725","DOI":"10.1093\/eurheartj\/ehl193","article-title":"EuroHeart failure survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population","volume":"27","author":"Nieminen","year":"2006","journal-title":"Eur Heart J"},{"key":"2026012113140918500_ehf214792-bib-0005","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1161\/circulationaha.107.696906","article-title":"Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure","volume":"116","author":"Solomon","year":"2007","journal-title":"Circulation"},{"key":"2026012113140918500_ehf214792-bib-0006","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1002\/ejhf.566","article-title":"European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions","volume":"18","author":"Crespo-Leiro","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0007","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.jacc.2022.11.023","article-title":"Worsening heart failure: nomenclature, epidemiology, and future directions: JACC review topic of the week","volume":"81","author":"Greene","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026012113140918500_ehf214792-bib-0008","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1111\/j.1472-8206.2009.00697.x","article-title":"Early worsening heart failure in patients admitted with acute heart failure \u2013 a new outcome measure associated with long-term prognosis?","volume":"23","author":"Weatherley","year":"2009","journal-title":"Fundam Clin Pharmacol"},{"key":"2026012113140918500_ehf214792-bib-0009","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1002\/ejhf.186","article-title":"Worsening heart failure, a critical event during hospital admission for acute heart failure: results from the VERITAS study","volume":"16","author":"Cotter","year":"2014","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0010","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1056\/NEJMoa1801291","article-title":"Effects of Serelaxin in patients with acute heart failure","volume":"381","author":"Metra","year":"2019","journal-title":"N Engl J Med"},{"key":"2026012113140918500_ehf214792-bib-0011","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1016\/j.cardfail.2009.04.001","article-title":"Early worsening heart failure in patients admitted for acute heart failure: time course, hemodynamic predictors, and outcome","volume":"15","author":"Torre-Amione","year":"2009","journal-title":"J Card Fail"},{"key":"2026012113140918500_ehf214792-bib-0012","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/s0140-6736(09)60622-x","article-title":"Relaxin for the treatment of patients with acute heart failure (pre-RELAX-AHF): a multicentre, randomised, placebo-controlled, parallel-group, dose-finding phase IIb study","volume":"373","author":"Teerlink","year":"2009","journal-title":"Lancet"},{"key":"2026012113140918500_ehf214792-bib-0013","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1093\/eurjhf\/hfq132","article-title":"Dyspnoea and worsening heart failure in patients with acute heart failure: results from the pre-RELAX-AHF study","volume":"12","author":"Metra","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0014","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1002\/ejhf.308","article-title":"Early vs. late worsening heart failure during acute heart failure hospitalization: insights from the PROTECT trial","volume":"17","author":"Mentz","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0015","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1002\/ejhf.1922","article-title":"Epidemiology, pathophysiology and contemporary management of cardiogenic shock \u2013 a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Chioncel","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0016","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.113.000590","article-title":"Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States","volume":"3","author":"Kolte","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2026012113140918500_ehf214792-bib-0017","doi-asserted-by":"publisher","first-page":"1942","DOI":"10.1002\/ejhf.2274","article-title":"Eligibility for mechanical circulatory support devices based on current and past randomised cardiogenic shock trials","volume":"23","author":"Schrage","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0018","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jchf.2015.01.007","article-title":"Worsening heart failure following admission for acute heart failure: a pooled analysis of the PROTECT and RELAX-AHF studies","volume":"3","author":"Davison","year":"2015","journal-title":"JACC Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0019","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1002\/ehf2.13202","article-title":"Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock","volume":"8","author":"Schrage","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0020","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3390\/jcdd8080088","article-title":"Acute kidney injury in cardiogenic shock: an updated narrative review","author":"Singh","year":"2021","journal-title":"J Cardiovasc Dev Dis"},{"key":"2026012113140918500_ehf214792-bib-0021","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1093\/eurheartj\/ehac528","article-title":"Albuminuria as a marker of systemic congestion in patients with heart failure","volume":"44","author":"Boorsma","year":"2022","journal-title":"Eur Heart J"},{"key":"2026012113140918500_ehf214792-bib-0022","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.jcmg.2018.09.027","article-title":"Morphologic types of tricuspid regurgitation: characteristics and prognostic implications","volume":"12","author":"Prihadi","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026012113140918500_ehf214792-bib-0023","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.1093\/eurheartj\/ehz614","article-title":"Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review","volume":"41","author":"Chang","year":"2019","journal-title":"Eur Heart J"},{"key":"2026012113140918500_ehf214792-bib-0024","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1093\/eurheartj\/ehy641","article-title":"Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis","volume":"40","author":"Wang","year":"2018","journal-title":"Eur Heart J"},{"key":"2026012113140918500_ehf214792-bib-0025","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1161\/CIRCULATIONAHA.119.039630","article-title":"Prognostic implications of right ventricular remodeling and function in patients with significant secondary tricuspid regurgitation","volume":"140","author":"Dietz","year":"2019","journal-title":"Circulation"},{"key":"2026012113140918500_ehf214792-bib-0026","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease: developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"43","author":"Vahanian","year":"2021","journal-title":"Eur Heart J"},{"key":"2026012113140918500_ehf214792-bib-0027","doi-asserted-by":"publisher","first-page":"2998","DOI":"10.1016\/j.jacc.2019.09.028","article-title":"Transcatheter versus medical treatment of patients with symptomatic severe tricuspid regurgitation","volume":"74","author":"Taramasso","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2026012113140918500_ehf214792-bib-0028","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2300525","article-title":"Transcatheter repair for patients with tricuspid regurgitation","author":"Sorajja","year":"2023","journal-title":"N Engl J Med"},{"key":"2026012113140918500_ehf214792-bib-0029","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1002\/ejhf.2664","article-title":"Congestion in heart failure: a circulating biomarker-based perspective. A review from the biomarkers working Group of the Heart Failure Association, European Society of Cardiology","volume":"24","author":"N\u00fa\u00f1ez","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0030","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1002\/ejhf.1366","article-title":"Adrenomedullin in heart failure: pathophysiology and therapeutic application","volume":"21","author":"Voors","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0031","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1002\/ejhf.1245","article-title":"Bio-adrenomedullin as a potential quick, reliable, and objective marker of congestion in heart failure","volume":"20","author":"Kremer","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0032","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1002\/ejhf.1437","article-title":"Bio-adrenomedullin as a marker of congestion in patients with new-onset and worsening heart failure","volume":"21","author":"Ter Maaten","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012113140918500_ehf214792-bib-0033","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1007\/s00392-021-01909-9","article-title":"Activity of the adrenomedullin system to personalise post-discharge diuretic treatment in acute heart failure","volume":"111","author":"Kozhuharov","year":"2022","journal-title":"Clin Res Cardiol"},{"key":"2026012113140918500_ehf214792-bib-0034","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1097\/mcc.0000000000000853","article-title":"Pathophysiology of cardiogenic shock","volume":"27","author":"Bertini","year":"2021","journal-title":"Curr Opin Crit Care"},{"key":"2026012113140918500_ehf214792-bib-0035","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1002\/ejhf.497","article-title":"Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation","volume":"18","author":"Ter Maaten","year":"2016","journal-title":"Eur J Heart Fail"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/11\/4\/2249\/64526901\/eschf_11_4_2249.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/11\/4\/2249\/64526901\/eschf_11_4_2249.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:15:48Z","timestamp":1769019348000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/11\/4\/2249\/8271193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,17]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,17]]},"published-print":{"date-parts":[[2024,8,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.14792","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,8]]},"published":{"date-parts":[[2024,4,17]]},"assertion":[{"value":"2023-08-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}