Do we need a simplified model to predict outcomes in patients hospitalized with Acute Decompensated Heart Failure? Results from The Role of Sodium in Heart Failure Outcomes Prediction (‘SHOUT-PREDICTION’) study

Abstract

Context Hyponatremia is associated with high in-hospital mortality in patients with acute decompensated Heart Failure (ADHF) and is one of the components in various risk scores in heart failure (HF). However, some risk scores predict outcomes in these patients without using hyponatremia as its component. Aim The study was aimed to evaluate the relationship between serum sodium levels at admission and clinical outcomes during the in-hospital course and three months’ follow-up, in patients admitted in the intensive cardiac care unit (ICCU) with ADHF. Methods and material This was a single-center prospective, observational study in which 130 consecutive patients admitted with ADHF were observed for clinical characteristics and blood investigation at admission and their clinical outcomes during the in-hospital course and follow-up of 3 months. Results Hyponatremia and systolic blood pressure (SBP) both were found to be the independent predictor of in-hospital mortality. The SXS score (calculated as a product of SBP and serum sodium, divided by 1000) as a new prediction variable was significantly associated with in-hospital mortality and was compared with the Get with the guideline HF (GWTG-HF) score and ADHF national registry (ADHERE) score. The SXS score showed the best overall accuracy in predicting in-hospital mortality [area under the curve (AUC) = 0.899] as compared to the ADHERE (AUC = 0.780) and the GWTG (AUC = 0.815). Conclusions A score derived from the product of serum sodium and SBP (SXS score) had a significant association with in-hospital mortality, and better predictive value as compared to GWTG and ADHERE risk score in these patients.

On the development and validation of the SXS model for ADHF

“…We read with great interest the article by Soni, et al., titled “Do we need a simplified model to predict outcomes in patients hospitalized with Acute Decompensated Heart Failure? Results from the Role of Sodium in Heart Failure Outcomes Prediction ('SHOUT-PREDICTION') study.” While this study appropriately highlighted the importance of SBP and serum sodium as prognostic indicators in ADHF, 1 there were some limitations that we would like to discuss: The study did not divide the sample into model derivation and model validation groups. Traditionally, predictive models are built on a training data set, and then evaluated on a separate validation data set.…”

Reply to a letter to the editor written by Phansalkar et al, regarding publication entitled “Do we need a simplified model to predict outcomes in patients hospitalized with Acute Decompensated Heart Failure? Results from The Role of Sodium in Heart Failure Outcomes Prediction (‘SHOUT-PREDICTION’) study. Indian Heart J. 2021;73(4):458–463. doi:10.1016/j.ihj.2021.06.007”

“…This has been already mentioned in the original manuscript as the limitation of this study. 1 However, use of this SXS score model in a different data set will be useful for its validation. Another concern was related to the serum urea and serum creatinine, which were non-significant predictors in this study, as this population subset may differ from other studies, moreover in another large study (GWTG-HF data), serum creatinine was not amongst independent predictors of in-hospital death unlike serum sodium and systolic blood pressure.…”