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Internal Medicine Clinic, University Clinical Centre Tuzla , Tuzla , Bosnia and Herzegovina
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Internal Medicine Clinic, University Clinical Centre Tuzla , Tuzla , Bosnia and Herzegovina
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Internal Medicine Clinic, University Clinical Centre Tuzla , Tuzla , Bosnia and Herzegovina
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Department of Neurology, Cantonal Hospital Zenica , Zenica
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Department of Cardiology, University Clinical Center Sarajevo , Sarajevo , Bosnia and Herzegovina
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Department of Gynecology and Obstetrics, University Clinical Centre Ljubljana , Ljubljana , Slovenia
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University of Tuzla, School of Medicine , Tuzla , Bosnia and Herzegovina
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School of Medicine, University of Tuzla , Tuzla , Bosnia and Herzegovina
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Department of Surgery, Cantonal Hospital Bihać , Bihać , Bosnia and Herzegovina
Department of Neurosurgery, Cantonal Hospital Zenica, University of Zenica , Zenica , Bosnia and Herzegovina
Aim To identify predictors of all-cause mortality and 6-month rehospitalisation in patients with hypertensive crisis, focusing on inflammatory indices, metabolic markers measured at admission, and antihypertensive treatment profiles.
Methods This prospective observational study included 210 adult patients with hypertensive crisis. Demographic, clinical, and therapeutic data were collected, including data on comorbidities, antihypertensive drug use, and treatment adherence. Laboratory parameters obtained at admission included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), homocysteine, and uric acid. Patients were followed for 12 months. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors.
Results Mortality occurred in 10.9% of patients, and 27.1% were rehospitalised within 6 months. Deceased patients exhibited significantly higher levels of PLR (p=0.0329), SII (p=0.0355), homocysteine (p=0.0488), and uric acid (p=0.021). In multivariate analysis, homocysteine (OR=3.55; p<0.001), uric acid (OR=1.03; p=0.007), PLR (OR=1.04; p=0.047), and SII (OR=1.01; p=0.030) remained independently associated with mortality. Chronic kidney disease (OR=2.15, p=0.012) and poor treatment adherence (OR=1.92; p=0.017) were also significant predictors. ROC analysis demonstrated moderate discriminative power, with AUC values of 0.68 for PLR, 0.66 for SII, 0.65 for homocysteine, and 0.63 for uric acid.
Conclusion Elevated inflammatory indices and metabolic markers, particularly homocysteine and uric acid, were independently associated with increased mortality risk. Additionally, chronic kidney disease and suboptimal adherence to antihypertensive therapy significantly contributed to adverse outcomes. These findings underscore the importance of comprehensive risk assessment and personalised management in this high-risk population.
Conceptualization, E.B., M.B., A.B. and A.Š.; Data curation, E.B., M.B., A.Š., K.L., N.L., A.A. and E.B.; Formal Analysis, E.B., M.B., A.D.K., K.L., N.L., A.A. and E.B.; Funding acquisition, E.B., M.B., A.B., A.D.K., A.Š. and A.A.; Investigation, E.B., M.B., A.B., A.D.K., K.L., L.B., N.L. and A.A.; Methodology, E.B., M.B., A.B., A.D.K., A.Š., K.L., L.B. and E.B.; Project administration, E.B., M.B., A.B., A.D.K., A.Š., K.L., L.B. and N.L.; Resources, E.B., M.B., A.B., K.L., L.B. and E.B.; Software, E.B., M.B., A.D.K., K.L., N.L. and E.B.; Supervision, E.B., M.B., A.B., A.D.K. and L.B.; Validation, E.B., M.B., A.B. and A.Š.; Visualization, E.B., M.B., A.D.K., N.L. and E.B.; Writing – original draft, E.B., M.B. and A.B.; Writing – review & editing, E.B., M.B., A.B., A.Š., N.L., A.A. and E.B. All authors have read and agreed to the published version of the manuscript.
The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to patient confidentiality and institutional regulations, access to raw data may be limited.
No specific funding was received for this study.
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