Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale
Por:
Jacob, J, Miro, O, Herrero, P, Martin-Sanchez, F, Gil, V, Tost, J, Aguirre, A, Escoda, R, Alquezar, A, Andueza, J, Llorens, P and Grp ICA-SEMES
Publicada:
1 ago 2016
Categoría:
Critical care and intensive care medicine
Resumen:
Introduction and objectives: Prognostic scales are needed in acute
exacerbation of chronic heart failure to detect early mortality. The
objective of this study is to create a prognostic scale (scale EAHFE-3D)
to stratify the risk of death the very short term.
Patients and method: We used the EAHFE database, a multipurpose,
multicenter registry with prospective follow-up currently including
6,597 patients with acute heart failure attended at 34 Spanish Emergency
Departments from 2007 to 2014. The following variables were collected:
demographic, personal history, data of acute episode and 3-day
mortality. The derivation cohort included patients recruited during 2009
and 2011 EAHFE registry spots (n = 3,640). The classifying variable was
all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the
results of the multivariate analysis based on the weight of the OR was
created. The 3D-EAHFE scale was validated using the cohort of patients
included in 2014 spot (n = 2,957).
Results: A total of 3,640 patients were used in the derivation cohort
and 102 (2.8%) died at 3 days. The final scale contained the following
variables (maximum 165 points): age >= 75 years (30 points), baseline
NYHA III-IV (15 points), systolic blood pressure < 110 mmHg (20 points),
room-air oxygen saturation < 90% (30 points), hyponatremia (20 points),
inotropic or vasopressor treatment (30 points) and need for noninvasive
mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI
0.76-0.84; P < .001). The validation cohort included 2,957 patients (66
died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95%
CI 0.70-0.82; P < .001). The risk groups consisted of very low risk
(0-20 points), low risk (21-40 points), intermediate risk (41-60
points), high risk (61-80 points) and very high risk (>80 points), with
a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8,
5.5/5.8 and 12.7/22.4%, respectively.
Conclusions: EAHFE-3D scale may help to predict the very short term
prognosis of patients with acute heart failure in 5 risk groups. (C)
2015 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.
Filiaciones:
Jacob, J:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Miro, O:
Hosp Clin Barcelona, Grp Invest Urgencias Proc & Patol, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Area Urgencias, Barcelona, Spain
Herrero, P:
Hosp Univ Cent Asturias, Serv Urgencias, Oviedo, Asturias, Spain
Martin-Sanchez, F:
Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Serv Urgencias, Inst Invest Sanitaria, Madrid, Spain
Gil, V:
Hosp Clin Barcelona, Grp Invest Urgencias Proc & Patol, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Area Urgencias, Barcelona, Spain
Tost, J:
Consorci Sanitari Terrassa, Serv Urgencias, Barcelona, Spain
Aguirre, A:
Hosp del Mar, Serv Urgencias, Barcelona, Spain
Escoda, R:
Hosp Clin Barcelona, Grp Invest Urgencias Proc & Patol, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Area Urgencias, Barcelona, Spain
Alquezar, A:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Andueza, J:
Hosp Gregorio Maranon, Serv Urgencias, Madrid, Spain
:
Hosp Gen Alicante, Unidad Corta Estancia, Alicante, Spain
Hosp Gen Alicante, Serv Urgencias, Unidad Hospitalizat Domicilio, Alicante, Spain
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