Risk Score For 30-day Mortality Research Articles

Abstract 14648: Can GRACE Risk Score Predict Mortality in Pulmonary Embolism?

Introduction Risk stratifying of pulmonary embolism (PE) patients and treatment for normotensive patients is still challenging. We aimed to assess the utility of GRACE risk score for 30-day mortality. Methods All consecutive patients hospitalized with a diagnosis of PE between2016 -2021 were included in this retrospective study. GRACE and PESI scores were calculated online. Results A total of 197 patients were enrolled. Mean age was 63.98±15.51. 56 of patients died by the end of the 30-day. When patients divided into 2 groups according to 30-day mortality, both groups were similar in terms of gender, hypertension, diabetes mellitus, coronary artery disease, heart failure and chronic obstructive pulmonary disease. Troponin level (212.4± 24.6 vs. 850.8±231.1; p<0.0001), PESI (122.3±27.2 vs. 170.1±49.1; p<0.0001) and GRACE (127.1±28.8 vs. 182±21.3; p<0.0001) were significantly higher in non-survivor group. The correlation analysis we observed strong positive correlation between PESİ and GRACE (r=0.732; p<0.0001). Regression analysis revealed that only GRACE score [p=0.021, β: 1.146, OR (95% CI): 1.021-1.286] was an independent risk factor associated with 30-day mortality. ROC curve for accuracy of GRACE score for predicting 30-day mortality in PE patients is shown in figure 1. Area under curve (AUC) for GRACE score was 0.969 [%95 CI: 0.948-0.990]. A cut off value of 161.5 for GRACE score was associated with 90.0% sensitivity and 89.7% specificity in prediction of 30-day mortality. Conclusion In this study, the relation between GRACE score and the clinical course of PE patients evaluated and we found GRACE risk score as an independent risk factor associated with 30-day mortality and strong correlation between GRACE and PESİ risk scores. To predict the mortality of high-risk normotensive and hypotensive PE patients,GRACE risk score exhibited high specificity and positive probability.

TCT-82 Acute Coronary Syndrome–Cardiogenic Shock Risk Score for 30-Day Mortality

TCT-82 Acute Coronary Syndrome–Cardiogenic Shock Risk Score for 30-Day Mortality

Chest radiograph-based artificial intelligence predictive model for mortality in community-acquired pneumonia

BackgroundChest radiograph (CXR) is a basic diagnostic test in community-acquired pneumonia (CAP) with prognostic value. We developed a CXR-based artificial intelligence (AI) model (CAP AI predictive Engine: CAPE) and prospectively...

Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI

BackgroundCardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is associated with a disproportionately higher risk of mortality. We described the contemporary presentation, management, and outcomes of CA patients in the era of primary percutaneous coronary intervention (PCI). MethodsWe reviewed 1,272 consecutive STEMI patients who underwent PCI between 1/1/2011-12/31/2016 and compared characteristics and outcomes between non-CA (N = 1,124) and CA patients (N = 148), defined per NCDR definitions as pulseless arrest requiring cardiopulmonary resuscitation and/or defibrillation within 24-hr of PCI. ResultsMale gender, cerebrovascular disease, chronic kidney disease, in-hospital STEMI, left main or left anterior descending culprit vessel, and initial TIMI 0 or 1 flow were independent predictors for CA. CA patients had longer door-to-balloon-time (106 [83,139] vs. 97 [74,121] minutes, p = 0.003) and greater incidence of cardiogenic shock (48.0% vs. 5.9%, p < 0.001), major bleeding (25.0% vs. 9.4%, p < 0.001), and 30-day mortality (16.2% vs. 4.1%, p < 0.001). Risk score for 30-day mortality based on presenting characteristics provided excellent prognostic accuracy (area under the curve = 0.902). However, over long-term follow-up of 4.5 ± 2.4 years among hospital survivors, CA did not portend any additional mortality risk (HR: 1.01, 95% CI: 0.56–1.82, p = 0.97). ConclusionsIn a contemporary cohort of STEMI patients undergoing primary PCI, CA occurs in >10% of patients and is an important mechanism of mortality in patients with in-hospital STEMI. While CA is associated with adverse outcomes, it carries no additional risk of long-term mortality among survivors highlighting the need for strategies to improve the in-hospital care of STEMI patients with CA.

The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction.

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) still reaches excessively high mortality rates. This analysis is aimed to develop a new easily applicable biomarker-based risk score. A biomarker-based risk score for 30-day mortality was developed from 458 patients with CS complicating AMI included in the randomized CULPRIT-SHOCK trial. The selection of relevant predictors and the coefficient estimation for the prognostic model were performed by a penalized multivariate logistic regression analysis. Validation was performed internally, internally externally as well as externally in 163 patients with CS included in the randomized IABP-SHOCK II trial. Blood samples were obtained at randomization. The two trials are registered with ClinicalTrials.gov (NCT01927549 and NCT00491036), are closed to new participants, and follow-up is completed. Out of 58 candidate variables, the four strongest predictors for 30-day mortality were included in the CLIP score (cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide). The score was well calibrated and yielded high c-statistics of 0.82 [95% confidence interval (CI) 0.78-0.86] in internal validation, 0.82 (95% CI 0.75-0.89) in internal-external (temporal) validation, and 0.73 (95% CI 0.65-0.81) in external validation. Notably, it outperformed the Simplified Acute Physiology Score II and IABP-SHOCK II risk score in prognostication (0.83 vs 0.62; P < 0.001 and 0.83 vs. 0.76; P = 0.03, respectively). A biomarker-only score for 30-day mortality risk stratification in infarct-related CS was developed, extensively validated and calibrated in a prospective cohort of contemporary patients with CS after AMI. The CLIP score outperformed other clinical scores and may be useful as an early decision tool in CS.

354 Pre-operative Risk Score Predicts 30-day Mortality Following Subdural Hematoma Evacuation

Abstract INTRODUCTION Subdural hematoma (SDH) evacuation is a common neurosurgical procedure with high risk for morbidity and mortality. The purpose of this study was to develop a risk score for 30-day mortality following SDH evacuation on the basis of readily available pre-operative information. METHODS Data recorded in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database between 2006 and 2014 were selected on the basis of ICD-9 (International Classification of Diseases, Ninth ed.) and CPT (Current Procedural Terminology) coding. Sequential univariate and multivariate analyses were used to identify significant independent predictors of 30-day mortality among 32 pre- operative factors. Multivariate regression coefficients were used to develop a weighted risk score capable of separating outcome groups with high sensitivity and specificity. RESULTS &gt;Following list-wise exclusion of patients with incomplete datasets, 1271 patients (35.6% F; median age 73.0 years, IQR 44.1-89.0 years) were examined. Sequential univariate and multivariate analysis identified seven independent predictors of 30-day mortality (OR = adjusted odds ratio): emergency case (OR 2.27), age &gt;= 65 years (OR 2.42), ventilator dependent status (OR 4.95), dialysis (OR 5.16), bleeding disorder (OR 2.37), WBC count &gt;= 10,000 mu;L-1 (OR 1.79), and platelets &lt;150,000 μL-1 (OR 2.18). Receiver operating characteristic (ROC) analysis demonstrated impressive outcome discrimination (area under the curve = 0.82, CI 5–95% = 0.78 0.86). Optimal score threshold was used to identify high-risk (mortality 35.0%) and low-risk (mortality 6.33%) patient groups. CONCLUSION We demonstrate a novel risk score capable of classifying patients based on 30-day postsurgical mortality. Application will provide an improved means of predicting outcomes for patients undergoing craniotomy or craniectomy for SDH evacuation.

WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database

Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy. We reviewed cases of pancreaticoduodenectomy from 2005-2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development cohort. Scores were created using weighted beta coefficients, and predictive accuracy was assessed on the validation cohort using receiver operator characteristic curves and measuring area under the curve. The 30-day mortality rate was 2.7% for patients who underwent pancreaticoduodenectomy (n=14,993). We identified 8 independent risk factors. The score created from weighted beta coefficients had an area under the curve of 0.71 (95% confidence interval, 0.66-0.77) on the validation cohort. Using the score WHipple-ABACUS (hypertension With medication+History of cardiac surgery+Age >62 +2×Bleeding disorder+Albumin <3.5g/dL+2×disseminated Cancer+2×Use of steroids+2× Systemic inflammatory response syndrome), mortality rates increase with increasing score (P<.001). While other risk scores exist for 30-day mortality after pancreaticoduodenectomy, we present a simple, validated score developed using exclusively preoperative predictors surgeons could use to identify patients at risk for this procedure.