January 15, 20210 citationsOpen Access

A New Scoring System for Predicting Short-term Outcomes in Critically-ill Acute Decompensated Heart Failure

PICO estructurado

Does a new multiparametric scoring system accurately predict short-term adverse outcomes in critically-ill ADHF patients compared to existing scores?

Población

1,268 critically-ill acute decompensated heart failure (ADHF) patients admitted to the ICU from the emergency department, median age 58, 68.8% male (derivation cohort), single-center (China). Excluded: known malignancy, STEMI, and NSTEMI.

Intervención

A novel multiparametric scoring system based on six risk factors: systolic blood pressure <90 mmHg, white blood cell count >9.2x10^9/L, hematocrit ≤0.407, total bilirubin >34.2 μmol/L, eGFR <15 ml/min/1.73m2, and NT-proBNP ≥10728.9 ng/ml.

Comparador

Existing clinical scoring systems (APACHE Ⅱ, AHEAD, and ADHERE scores).

Resultado

Composite of in-hospital mortality, in-hospital cardiac arrest, or utilization of mechanical support devices (intra-aortic balloon pumps and extracorporeal membrane oxygenation).composite

A novel 6-parameter scoring system demonstrated superior discrimination for predicting short-term adverse outcomes in critically-ill ADHF patients compared to existing scores like APACHE Ⅱ and ADHERE.

Limitaciones

Single-center study
Retrospective design
Inability to accurately predict heart transplantation

Resumen

Abstract Background: Acute decompensated heart failure (ADHF) contributes millions of emergency department (ED) visits and it is associated with high in-hospital mortality. The aim of this study was to develop and validate a multiparametric score for critically-ill ADHF patients.Methods: In this single-center, retrospective study, a total of 1268 ADHF patients were enrolled and divided into derivation (n=1014) and validation (n=254) cohorts. The primary endpoint was any in-hospital death, cardiac arrest or utilization of mechanical support devices. Logistic regression model was preformed to identify risk factors and build the new scoring system. The assigning point of each parameter was determined according to its β coefficient. The discrimination was validated internally using C statistic and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit test. Results: We constructed a predictive score based on six significant risk factors systolic blood pressure (SBP), white blood cell (WBC) count, hematocrit (HCT), total bilirubin (TBIL), estimated glomerular filtration rate (eGFR) and NT-proBNP. This new model was computed as (1×SBP9.2×10 9 /L)+(1×HCT≤0.407)+(2×TBIL>34.2μmol/L)+(2×eGFR<15ml/min/1.73m 2 )+(1×NTproBNP≥10728.9ng/ml). The C statistic for the new score was 0.758 (95%CI 0.667 to 0.838) higher than APACHE Ⅱ, AHEAD and ADHERE score. It also demonstrated good calibration for detecting high-risk patients in the validation cohort (χ 2 =6.681, p=0.463).Conclusions: The new score including SBP, WBC, HCT, TBIL, eGFR and NT-proBNP might be used to predict short-term prognosis of critically-ill ADHF patients.

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