The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure

详细信息    查看全文

• 作者：Domenico Scrutinio ; MD^a ; ^{domenico.scrutinio@fsm.it" class="auth_mail} ; Enrico Ammirati ; MD^b ; ^c ; Pietro Guida ; PhD^a ; Andrea Passantino ; MD^a ; Rosa Raimondo ; MD^d ; Valentina Guida ; MD^b ; Simona Sarzi Braga ; MD^d ; Paolo Canova ; MD^b ; Filippo Mastropasqua ; MD^a ; Maria Frigerio ; MD^b ; Rocco Lagioia ; MD^a ; Fabrizio Oliva ; MD^b
• 关键词：advanced decompensated heart failure ; risk stratification ; ADHF/NT-proBNP score ; Seattle Heart Failure Model score
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：April, 2014
• 年：2014
• 卷：33
• 期：4
• 页码：404-411
• 全文大小：1003 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Background

The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF).

Methods

We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged 鈮?70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive.

Results

During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score鈥檚 C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged 鈮?70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (鈮? months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged 鈮?70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at .

Conclusions

Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF.