The Modified Harborview Risk Score Successfully Predicts Mortality after Ruptured Abdominal Aortic Aneurysm Repair

BACKGROUND: The traditional Harborview Risk Score uses 4 criteria to predict mortality after surgical repair of ruptured abdominal aortic aneurysms (rAAAs): preoperative minimum systolic blood pressure <70 mm Hg, creatinine >2.0 mg/dL, age >76 years and preoperative arterial pH < 7.2. Difficulties obtaining arterial pH values limit the clinical utility of this score. The international normalized ratio (INR > 1.8) has been proposed as an acceptable substitution when arterial blood gases are not available preoperatively. Preliminary studies have shown that the accuracy of the score is not compromised when using this modified criterion. The objective of this study is to validate the modified Harborview Risk Score (mHRS). METHODS: We conducted a retrospective analysis of all patients presenting with rAAA at a single tertiary-care center from 2011 to 2022. The Vascular Study Group of New England (VSGNE) score was used for comparison. The primary outcome was 30-day mortality. Logistic regression and receiver operating characteristic curves were used to evaluate the predictability of each score. Categorical and continuous data were compared using Chi-squared and Student's t-tests, respectively. RESULTS: = 0.94). There was no significant difference in the areas under the receiver operating characteristic curves between the mHRS and VSGNE scores (0.70 [0.56-0.83], P = 0.007 vs. 0.69 [0.56-0.82], P = 0.01, respectively). Logistic regression analysis showed a significant correlation between creatinine (4.0 [1.2-13.8], P = 0.03), systolic blood pressure (3.8 [1.3-11.1], P = 0.02), and age (1.7 [1.1-7.4], P = 0.04) and 30-day mortality. CONCLUSION: The mHRS accurately predicted 30-day mortality after rAAA repair using INR > 1.8. By using easily obtainable preoperative variables, the mHRS has broader clinical utility, making it a superior scoring system to the traditional Harborview Risk Score and VSGNE scores.