Key result
Admission qSOFA ≥2 linked to ~153% higher 30-day mortality or HF readmission risk.
Why the study?
Existing mortality prediction scores for acute decompensated heart failure rely on complex regression models that lack wide clinical adoption, leaving no gold standard for outcome prediction.
Does a qSOFA score ≥2 at admission predict worse 30-day outcomes in patients with acute decompensated heart failure?
Cohort (n=240)
No
Does a qSOFA score ≥2 at admission predict worse 30-day outcomes in patients with acute decompensated heart failure?
Absolute Event Rate: 48% vs 19%
p-value: p=0.002
The qSOFA score assessed at admission is a simple and useful tool to identify patients with acute decompensated heart failure at high risk for 30-day mortality or readmission.
qSOFA ≥2 was associated with higher 30-day events in ADHF; hypothesis-generating for risk stratification, prospective validation needed before practice change.
Aims There is no gold standard to predict outcome in acute decompensated heart failure (ADHF). Several scores for mortality prediction of patients with ADHF have been developed and mostly consist of complex regression models. None of these models has been widely adopted by clinicians. The quick SOFA score (qSOFA) is a simple score including three parameters (systolic blood pressure ≤100 mmHg, respiratory rate ≥22 breathes/min, and GCS <15) and is validated for discrimination of mortality risk in septic patients. Here, we adapted qSOFA score to patients admitted to a Heart Failure Unit (HFU) and assessed the prognostic accuracy. Methods and Results qSOFA, SOFA score and SIRS criteria were assessed at admission. Clinical, laboratory and echocardiographic parameters were recorded. A follow-up was performed 30 days after discharge. Primary outcome was all-cause mortality or readmission to hospital due do worsening of heart failure symptoms. Of 240 patients (73% male, 16-93 years), 25 patients (10%) had a qSOFA ≥2 points and 126 patients (53%) fulfilled none of qSOFA criteria. Within 30 days, the primary endpoint occurred in 46 patients (19%). Seventeen patients (7%) died and 34 patients (14%) were readmitted to hospital due to worsening heart failure. Patients with qSOFA ≥2 reached this endpoint more frequently (48% vs. 19%, p=0.002), had more often dyspnea NYHA III-IV (OR 2.4, p=0.005) and a higher risk for multi organ failure during hospital stay (28% vs. 9%, P=0.005). Conclusions qSOFA is useful to identify patients with heart failure at high risk for worse outcome and to operationalize severity of decompensation.
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Wagner et al. (2020) conducted a cohort in Acute decompensated heart failure (n=240). qSOFA score ≥ 2 vs. qSOFA score < 2 was evaluated on All-cause mortality or readmission to hospital due to worsening of heart failure symptoms (p=0.002). A qSOFA score of ≥2 at admission was associated with a significantly higher rate of 30-day all-cause mortality or readmission for worsening heart failure compared to lower scores (48% vs 19%).
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