The BE-ALIVE score: predicting 30-day mortality in patients presenting with acute coronary syndromes and cardiogenic shock

Abstract

Abstract Aims The aim of this study was to create and validate a simple scoring system for predicting 30-day mortality in patients presenting with acute coronary syndromes (ACS) and any sign of shock at their moment of admission. Methods and results 2407 consecutive patients presenting to Harefield Hospital with clinical features of cardiogenic shock, from January 2011 to December 2020, were studied to build the training set. 30-day mortality was 17.2%. A scoring algorithm was built using binary logistic regression of variables available on admission and then converted to an additive risk score. The resultant scoring system is the BE-ALIVE score, which incorporates the following factors: Base Excess (1 point for < -2 mmols/L), Age (<65 years: 0 points, 65-74: 1 point, 75-84: 2 points, ³85: 3 points), Lactate (<2 mmols/L: 0 points, 2 - 4.9: 1 point, 5 - 9.9: 3 points, ³10: 6 points), Intubated (2 points), Left Ventricular function (mildly impaired or better: -1 point, moderately impaired: 1 point, severely impaired: 3 points) and External / out of hospital cardiac arrest (1 point). The scoring system was validated using a testing set of 515 patients presenting to Harefield hospital. The validation metrics were excellent with an AUC of 0.9, Brier score of 0.06 versus a naïve classifier of 0.15, Spiegelhalter’s z-statistic probability of 0.267 and a calibration slope of 1.08. Conclusion The BE-ALIVE score is a simple and accurate scoring system to predict 30-day mortality in patients presenting with ACS and shock.