Josip A Borovac1, Duska Glavas2, Josko Bozic3, Katarina Novak4. 1. Department of Pathophysiology, University of Split School of Medicine, Split, Croatia; University Hospital of Split, Split, Croatia; Working Group on Heart Failure of Croatian Cardiac Society, Croatia. Electronic address: jborovac@mefst.hr. 2. Department of Cardiology, University Hospital of Split, Split, Croatia; Department of Internal Medicine, University of Split School of Medicine, Split, Croatia; Working Group on Heart Failure of Croatian Cardiac Society, Croatia. 3. Department of Pathophysiology, University of Split School of Medicine, Split, Croatia. 4. Department of Internal Medicine, University of Split School of Medicine, Split, Croatia.
Abstract
BACKGROUND: Acute heart failure (AHF) is a complex syndrome associated with high morbidity and mortality. This study aimed to derive a simple risk score with which to identify AHF patients at high risk for an all-cause death event during the first year after hospital discharge. METHODS: Three hundred AHF patients from the Heart Failure registry were included in the analysis. Cox regression with a forward-conditional algorithm and bootstrapping procedure was used to build the prognostic score, while c-statistic was used to assess the prognostic performance of the score. RESULTS: Seven variables were independently associated with an all-cause mortality event during the 1-year follow-up (FU): estimated glomerular filtration rate of 40-60; estimated glomerular filtration rate <40 mL/min/1.73 m2; uric acid >450 μmol/L; left-ventricular ejection fraction <45%; sodium <136 mmol/L; systolic blood pressure <115 mmHg; and a positive history of previous heart failure-related decompensation event(s). The score derived from significant variables enabled classification of patients into three risk categories: low (0-2 points), intermediate (3 points), and high (4-6 points). Observed all-cause mortality rates during the 1-year FU were 6.1%, 30.5%, and 80.9% across the three risk categories, respectively. The score demonstrated a high level of discrimination for an all-cause death event in the derivation cohort with the c-statistic value of 0.907 (95% CI, 0.867-0.939; p < 0.0001) and adequate calibration. CONCLUSIONS: The S2PLiT-UG score is a simple tool with potential for facilitating risk stratification and therapeutic decision-making during the first year after hospitalisation for an AHF event. Future external validation studies are required to confirm its prognostic performance.
BACKGROUND:Acute heart failure (AHF) is a complex syndrome associated with high morbidity and mortality. This study aimed to derive a simple risk score with which to identify AHF patients at high risk for an all-cause death event during the first year after hospital discharge. METHODS: Three hundred AHF patients from the Heart Failure registry were included in the analysis. Cox regression with a forward-conditional algorithm and bootstrapping procedure was used to build the prognostic score, while c-statistic was used to assess the prognostic performance of the score. RESULTS: Seven variables were independently associated with an all-cause mortality event during the 1-year follow-up (FU): estimated glomerular filtration rate of 40-60; estimated glomerular filtration rate <40 mL/min/1.73 m2; uric acid >450 μmol/L; left-ventricular ejection fraction <45%; sodium <136 mmol/L; systolic blood pressure <115 mmHg; and a positive history of previous heart failure-related decompensation event(s). The score derived from significant variables enabled classification of patients into three risk categories: low (0-2 points), intermediate (3 points), and high (4-6 points). Observed all-cause mortality rates during the 1-year FU were 6.1%, 30.5%, and 80.9% across the three risk categories, respectively. The score demonstrated a high level of discrimination for an all-cause death event in the derivation cohort with the c-statistic value of 0.907 (95% CI, 0.867-0.939; p < 0.0001) and adequate calibration. CONCLUSIONS: The S2PLiT-UG score is a simple tool with potential for facilitating risk stratification and therapeutic decision-making during the first year after hospitalisation for an AHF event. Future external validation studies are required to confirm its prognostic performance.
Authors: Ewa Romuk; Celina Wojciechowska; Wojciech Jacheć; Aleksandra Zemła-Woszek; Alina Momot; Marta Buczkowska; Piotr Rozentryt Journal: Oxid Med Cell Longev Date: 2019-10-09 Impact factor: 6.543