Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China

Abstract

Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.

Atherogenic index of plasma: a new indicator for assessing the short-term mortality of patients with acute decompensated heart failure

“…Statistics indicate that over 30% of ADHF patients require rehospitalization or face mortality shortly after discharge (within 90 days) (8)(9)(10)(11)39). In China, the 30day mortality rate for ADHF patients ranges between 1.65% and 13.17% (40)(41)(42)(43)(44)(45), while in the JX-ADHF1 cohort, it is approximately 4%, and in the current analysis, it is 3.37% after excluding certain subjects. ADHF has become one of the most challenging cardiovascular diseases to manage appropriately worldwide.…”

Risk prediction models for mortality and readmission in patients with acute heart failure: A protocol for systematic review, critical appraisal, and meta-analysis

“…On the other hand, several well-known models had been developed initially for prediction at specific time points and showed good performance [18,19], but have subsequently been used for validation at other time points and showed significantly different prediction performance at different time points [20,21]. Even at the same time point, when the same model was validated across the different cohorts, the performance varies considerably [15,[22][23][24][25][26].…”

Analysis of the Larissa Heart Failure Risk Score: Predictive Value in 9207 Patients Hospitalized for Heart Failure from a Single Center

“…Timely and precise risk stratification of HF patients is of outmost importance, especially in those acutely hospitalized, where the clinical decision is often challenging [5]. Consequently, several predictive scores have been evolved and validated in HHF [6][7][8][9]. Nonetheless, in the majority of these prognostic models, numerous parameters (multivariable risk scores) are incorporated, making their calculation difficult and frequently requiring the utilization of sophisticated calculators [10].…”