Mortality Prediction Score Research Articles

Performance of the EuroSCORE II and the STS score for cardiac surgery in octogenarians.

Background We aimed to investigate the predictive value of Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE II) scores for mortality in octogenarian cardiac surgery patients. Methods Between January 2016 and December 2019, cardiac operations performed in 116 octogenarian patients (73 males, 43 females; mean age: 82.9±3.1 years; range, 80 to 97 years) were retrospectively analyzed. The patients with and without mortality were compared for their demographic and operative factors. The STS and EuroSCORE II scores, and observed mortality rates were assessed. Results Mean STS score was 3.7±11.1 and mean EuroSCORE II was 5.2±5.4. For any operation type, the mean EuroSCORE II was significantly higher (8.1±7.4 vs. 4.1±4.0, respectively; p=0.006) in the patients with mortality. For elective operations, the mean EuroSCORE II was higher in cases with mortality (7.2±7.3 vs. 3.7±3.9, respectively; p=0.006); however, for urgent cases, there was no significant difference between the scores. Using the receiver operating characteristic curve, the EuroSCORE II had a higher area under the curve for all cases and elective cases than the STS scores. Conclusion The EuroSCORE II performed better than the STS score for mortality prediction in octogenarians, whereas the predictions of either scoring system was unsatisfactory for urgent surgery and combined procedures. Population-based validation studies are needed for a better risk scoring system in this age group.

Validation of Predictive Ability of Bobi Score in Burn Patients

Introduction: Scoring systems have been used successfully in burn centers to predict the prognosis and take measures for careful monitoring of the burned patient. Belgium Outcome Burn Injury score is one of them which takes into consideration age, burn surface area, and presence of inhalation burn. Objectives: This presentation aims to validate the use of the BOBI prognostic score in our patients. Patients and Methods: The study is a retrospective analytical study that utilized the investigation of the medical charts of 1515 patients hospitalized with severe burns within the ICU of the Service of Burns in Tirana, Albania during 2010-2019. Results: The overall mortality of our patients was 7.06% (107 deaths in 1515 patients). Up to BOBI score 6, we have noticed better mortality than prediction while there is a very good prediction up to score 10. Area Under the Curve was 0.978 (p<0.0001) which is an outstanding result in being a classifier between deaths and survivors. Conclusions: BOBI score is a very good prediction score for mortality in burn patients.

The analysis and accuracy of mortality prediction scores in burn patients admitted to the intensive care burn unit (ICBU)

BackgroundTo date, multiple scoring systems have been utilised in predicting outcomes in burn patients. The aim of this study is to determine the accuracy of three established scoring systems used for burn patients admitted to the intensive care unit and to determine the risk factors associated with poor outcomes. MethodsA total of 211 patients who were admitted to the ICBU in a tertiary care centre in Kuwait from January 2017 to December 2019 were analysed retrospectively. Data were collected using patient medical records. The FLAMES, BOBI and revised Baux scores were calculated, and the survivor and non-survivor scores of patients were analysed to determine the sensitivity, specificity and Area Under the Receiver Operating Characteristics (AUROC) of the different scoring modalities. ResultsThe majority of the analysed population were male patients (165/211) and the most common mechanism of burns was flame burns (166/211). Most of the patients admitted to the ICBU survived (188/211). Female gender was associated with a higher mortality rate, whilst inhalational injury and co-morbidities were not associated with a higher mortality rate. The revised Baux score had a sensitivity value of 96% and 90% specificity. The BOBI score had a sensitivity of 91% and 76% specificity. The FLAMES score had a sensitivity of 96% and the highest specificity of 99%. All 3 scores had AUC values exceeding 90%. ConclusionStatistically, FLAMES score had the highest accuracy of predicting outcomes in burn patients, however all three scores demonstrated acceptable predictive rates when it comes to practical application, permitting the use of either one of the studied scores with satisfactory prognostic outcomes.

Surfactant protein D: a predictor for severity of community-acquired pneumonia in children.

BackgroundSurfactant protein D (SP-D) is a promising biomarker proposed for the prediction of community-acquired pneumonia (CAP) severity. Therefore, we aimed to assess the role of SP-D in the prediction of CAP severity in pediatric patients.MethodsA prospective cohort study was carried out at the Pediatric Intensive Care Unit (PICU) and wards of Menoufia University Hospital. We recruited 112 children admitted into wards with pneumonia (simple pneumonia) and 68 children admitted into PICU with severe pneumonia (PICU admitted). World Health Organization (WHO) classification and mortality predictive scores were calculated to determine the severity of pneumonia for the two groups, including the Pediatric Respiratory Severity Score (PRESS) and the Predisposition, Insult, Response, and Organ dysfunction modified Score (PIROm). SP-D was measured at admission.ResultsThe SP-D level was significantly lower in patients with simple pneumonia than in patients with severe pneumonia (P < 0.001). SP-D was significantly higher among children with severe pneumonia, as determined by WHO, PRESS, and PIROm (P = 0.001). SP-D was significantly higher among children with mechanical ventilation, shock, hypoxia, sepsis, and mortality. Receiver operating characteristic curve analysis for SP-D showed that the area under the curve was 0.741 (P value < 0.001), with a sensitivity of 85.3% and a specificity of 44.6%.ConclusionsSerum SP-D level has a predictive value for the detection of community-acquired pneumonia severity in children.Impact SP-D is a good predictor for the detection of CAP severity in hospitalized children. SP-D was correlated with severity scores and was associated with indicators of CAP severity, including mechanical ventilation, shock, hypoxia, sepsis, and mortality.

Prognostic biomarkers in predicting mortality in respiratory patients with ventilator-associated pneumonia

BackgroundVentilator-associated pneumonia (VAP) is the most common nosocomial infection. Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are prognostic factors to mortality in different diseases. The aim of this study is to evaluate prognostic efficiency RDW, NLR, and the Sequential Organ Failure Assessment (SOFA) score for mortality prediction in respiratory patients with VAP.ResultsOne hundred thirty-six patients mechanically ventilated and developed VAP were included. Clinical characteristics and SOFA score on the day of admission and at diagnosis of VAP, RDW, and NLR were assessed and correlated to mortality. The average age of patients was 58.80 ± 10.53. These variables had a good diagnostic performance for mortality prediction AUC 0.811 for SOFA at diagnosis of VAP, 0.777 for RDW, 0.728 for NLR, and 0.840 for combined of NLR and RDW. The combination of the three parameters demonstrated excellent diagnostic performance (AUC 0.889). A positive correlation was found between SOFA at diagnosis of VAP and RDW (r = 0.446, P < 0.000) and with NLR (r = 0.220, P < 0.010).ConclusionsNLR and RDW are non-specific inflammatory markers that could be calculated quickly and easily via routine hemogram examination. These markers have comparable prognostic accuracy to severity scores. Consequently, RDW and NLR are simple, yet promising markers for ICU physicians in monitoring the clinical course, assessment of organ dysfunction, and predicting mortality in mechanically ventilated patients. Therefore, this study recommends the use of blood biomarkers with the one of the simplest ICU score (SOFA score) in the rapid diagnosis of critical patients as a daily works in ICU.

Generation and validation of in-hospital mortality prediction score in COVID-19 patients: Alba-score

Background COVID-19 has a wide range of symptoms reported, which may vary from very mild cases (even asymptomatic) to deadly infections. Identifying high mortality risk individuals infected with the SARS-CoV-2 virus through a prediction instrument that uses simple clinical and analytical parameters at admission can help clinicians to focus on treatment efforts in this group of patients. Methods Data was obtained retrospectively from the electronic medical record of all COVID-19 patients hospitalized in the Albacete University Hospital Complex until July 2020. Patients were split into two: a generating and a validating cohort. Clinical, demographical and laboratory variables were included. A multivariate logistic regression model was used to select variables associated with in-hospital mortality in the generating cohort. A numerical and subsequently a categorical score according to mortality were constructed (A: mortality from 0% to 5%; B: from 5% to 15%; C: from 15% to 30%; D: from 30% to 50%; E: greater than 50%). These scores were validated with the validation cohort. Results Variables independently related to mortality during hospitalization were age, diabetes mellitus, confusion, SaFiO2, heart rate and lactate dehydrogenase (LDH) at admission. The numerical score defined ranges from 0 to 13 points. Scores included are: age ≥71 years (3 points), diabetes mellitus (1 point), confusion (2 points), onco-hematologic disease (1 point), SaFiO2 ≤ 419 (3 points), heart rate ≥ 100 bpm (1 point) and LDH ≥ 390 IU/L (2 points). The area under the curve (AUC) for the numerical and categorical scores from the generating cohort were 0.8625 and 0.848, respectively. In the validating cohort, AUCs were 0.8505 for the numerical score and 0.8313 for the categorical score. Conclusions Data analysis found a correlation between clinical admission parameters and in-hospital mortality for COVID-19 patients. This correlation is used to develop a model to assist physicians in the emergency department in the COVID-19 treatment decision-making process.

The Production, Efficacy, and Safety of Machine-Generated Bicarbonate Solution for Continuous Venovenous Hemodialysis (CVVHD): The Cleveland Clinic Method

Rationale & ObjectiveSince 1994, the Nephrology and Hypertension Department at the Cleveland Clinic has prepared and used bicarbonate-based solution for continuous venovenous hemodialysis (CVVHD) using a standard volumetric hemodialysis machine rather than purchasing from a commercial vendor. This report describes the process of producing Cleveland Clinic UltraPure Solution (CCUPS), quality and safety monitoring, economic costs, and clinical outcomes.Study DesignRetrospective study.Setting & ParticipantsCVVHD experience at Cleveland Clinic, focusing on dialysate production, institutional factors, and patients requiring continuous kidney replacement therapy. Production is shown at www.youtube.com/watch?v=WGQgephMEwA.OutcomesFeasibility, safety , and cost.ResultsOf 6,426 patients treated between 2011 and 2019 with continuous kidney replacement therapy, 59% were men, 71% were White, 40% had diabetes mellitus, and 74% presented with acute kidney injury. 98% of patients were treated with CVVHD using CCUPS, while the remaining 2% were treated with either continuous venovenous hemofiltration or continuous venovenous hemodiafiltration using commercial solution. The prescribed and delivered effluent doses were 24.8 (IQR) versus 20.7 mL/kg/h (IQR), respectively. CCUPS was as effective in restoring electrolyte and serum bicarbonate levels and reducing phosphate, creatinine, and serum urea nitrogen levels as compared with packaged commercial solution over a 3-day period following initiation of dialysis, with a comparable effluent dose. Among those with acute kidney injury, mortality was similar to that predicted with the 60-day acute kidney injury predicted mortality score (r = 0.997; CI: 0.989-0.999). At our institution, the cost of production for 1 L of CCUPS is $0.67, which is considerably less than the cost of commercially purchased fluid.LimitationsObservational design without a rigorous control group.ConclusionsCVVHD using locally generated dialysate is safe and cost-effective.

Development of a Prediction Score for In-Hospital Mortality in COVID-19 Patients with Acute Kidney Injury: A Machine Learning Approach

Introduction: Acute kidney injury (AKI) is frequently associated to COVID-19, adding severity and increasing mortality risk.Objective: The aim of the study was to develop and validate a prognostic score at hospital admission for predicting in-hospital mortality in COVID-19 patients with AKI (AKI-COV score).Design: Cross-sectional multicenter prospective cohort study.Setting: The Latin America AKI COVID-19 Registry has been conducted in 57 cities in 12 countries from Latin America. Model training was performed on a cohort of patients admitted from May 1 to December 31, 2020. Participants: Eight hundred and seventy COVID-19 patients with AKI defined according KDIGO serum creatinine criteria were included between 01 March to 31 December 2020.Material and Methods: We evaluated four categories of predictor variables available at the time of AKI diagnosis: (1) demographic data; (2) comorbidities and condition at admission; (3) laboratory exams at admission; (4) characteristics and causes of AKI. We used a machine learning approach to fit models in the training set using 10-fold-cross validation. Predictors with more than 30% missing were removed. We select the best model and confirm the accuracy in a validation cohort using the area under the receiver operating characteristic curve (AUC-ROC).Main Outcome Measured: In-hospital mortality.Results: There were 544 (62.5%) in-hospital deaths. Increasing age, mechanical ventilation, use of vasopressors, leukocytosis, hypertension, severe condition at admission, AKI ethiology, and need kidney replacement therapies (KRT) were associated with increased risk of death. Longer time from symptoms to hospitalization or to AKI diagnosis, and higher urine output were associated with reduced risk of death. The coefficients of the best model (Elastic Net) were used to build the predictive ImAgeS score. The final model has an AUC-ROC of 0.823 [95% CI 0.761 – 0.885] in the validation cohort.Conclusion: We developed a predictive model using only demographic data, comorbidities, hospital admission condition, laboratory variables and causes of AKI that shows good accuracy and is easily applicable. The use of AKI-COV score may assist health-care workers in identifying hospitalized COVID-19 patients with AKI that may require more intensive monitoring and can be used for resource allocation.Funding Statement: This study was partially funded by Latin American Society of Nephrology and Hypertension (SLANH).Declaration of Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Ethics Approval Statement: The Institutional Review Board of the Clínica Los Olivos, Cochabamba, Bolivia approved the study.

Abstract P428: The Intracerebral Hemorrhage Score Overestimates Mortality in Young Adults

Introduction: The intracerebral hemorrhage (ICH) score is a widely used scoring system for predicting mortality in patients with ICH. This score has been validated for use in adults of all ages with ICH, but not specifically for use in populations of young adults (age 18-45). We aimed to determine the validity of the ICH score when applied to young adults with ICH. Methods: This was a retrospective analysis of all patients aged 18-45 with spontaneous ICH consecutively admitted to our institution from 2009-2019. We calculated the ICH score for each patient, recording the individual subcomponents, and analyzed the scores for prediction of mortality at 30 days. We also analyzed the individual subcomponents of the score for effect on mortality. Results: We identified 156 patients (mean age 35 +/- 7.8; 67 were female, 103 were white) to include in our study. The 30-day mortality rate was 15% (n=24); these patients had a mean age of 34.9 +/- 7.8, compared to survivors who had mean age 35.4 +/- 7.8 (p=0.797). ICH scores were predictive of mortality (p=0.036 for trend); however, the actual mortality rates in our population were substantially lower than those predicted by the ICH score. Specifically, patients in our population with scores of 1, 2, or 3 had 30-day mortality rates of 0%, 3%, and 41%, compared to the current ICH score mortality predictions of 13%, 26%, and 72%, respectively. Scores of 4 and 5 in our population were more closely aligned to current ICH predictions (85% and 100% compared to 97% and 100%, respectively). Of the ICH score subcomponents, ICH volume &gt;30mL (p=0.007) and Glasgow Coma Scale (GCS) scores of 3 or 4 (p=0.014) were the strongest predictors of mortality at 30 days. Conclusion: The ICH score is predictive of mortality for adults of all ages, but the specific mortality rates associated with this scoring system vary considerably when applied to young adults (age 18-45). This over-estimation should be taken into consideration when applying the predictions of the ICH score to young adults with ICH; additionally, special attention should be given to ICH volume &gt;30mL and very low GCS scores, as these were the strongest predictors of early mortality.

Vasoactive-inotropic Score for Early Detection and Mortality Prediction of Sepsis in Children

BACKGROUND: Early detection and treatment of sepsis can prevent septic shock and reduce mortality rate. Troponin can become a prognostic factor in sepsis. However, not all health facilities are equipped to assess troponin levels. Vasoactive-inotropic score (VIS) is a simpler and more accessible method to describe hemodynamic status. The aim of this study was to assess the suitability of VIS score as early prognosis and mortality predictor of sepsisMETHODS: A retrospective study was conducted to determine the correlation between VIS and troponin levels for sepsis cases in Pediatric Intensive Care Unity (PICU) Haji Adam Malik Hospital, Medan from January 2018 to December 2019. VIS score at 48 hours, maximum VIS score, pediatric logistic organ dysfunction-2 (PELOD-2) score, cardiac troponin levels at 48 hours were taken from medical records.RESULTS: There were 54 samples analyzed. VIS scores were positively correlated (p&lt;0.001) to troponin T and troponin I levels at 48 hours (r=0.670 and r=0.606, respectively). VIS at 48 hours and maximum VIS were related to mortality (p=0.001 and p&lt;0.001, respectively). VIS score at 48 hours could be used as a predictive factor for mortality (area under the curve (AUC): 79.7%, p&lt;0.001) with a cut-off point at 11 (74.4% sensitivity and 80% specificity). High VIS at 48 hours indicated poor outcomes of sepsis in children with odd ratio (OR) value: 1.99 (95% confidence interval (CI): 1.25-3.19).CONCLUSION: Vasoactive-inotropic score was suitable as an alternative to cardiac troponin T and troponin I levels at 48 hours to early detect myocardial dysfunctions and mortality in children.KEYWORDS: troponin, vasoactive-inotropic score, sepsis, children, mortality

A New Index for the Prediction of 30-Day Mortality in Patients With Pulmonary Embolism: The Pulmonary Embolism Mortality Score (PEMS).

Our aim was to analyze possibility of combination of basic clinical and radiological signs to predict 30-day mortality after acute pulmonary embolism (PE). We included 486 patients. Age, gender, simplified pulmonary embolism index (sPESI), pH, troponin, N-terminal natriuretic peptide, minimal systolic and diastolic blood pressure, O2 saturation, syncope, need for vasopressors, thrombotic obstruction, vessel diameter, short axis ratio right ventricle/left ventricle, and contrast medium reflux into the inferior vena cava (IVC) were analyzed. A backward algorithm in a logistic regression model was used to identify relevant risk factors. Multiple logistic regression analysis identified that sPESI, pH, minimal diastolic blood pressure, IVC reflux, and need for vasopressors influenced 30-day mortality. A score for mortality prediction was constructed (the Pulmonary Embolism Mortality Score): sPESI >2 points (1 point), pH <7.35 (1 point), minimal diastolic blood pressure <45 mm Hg (1 point), IVC reflux (1 point), and need for vasopressors (2 points). Patients with >3 points showed higher 30-day mortality (sensitivity: 84.9%, specificity: 83.0%, positive predictive value: 51.8%, negative predictive value: 96.2%). The net reclassification improvement compared with the sPESI was 0.94 (95% CI = 0.73-1.15). In conclusion, a new score can predict 30-day mortality in patients with PE and is more sensitive than sPESI.

Development and Validation of a Sepsis Mortality Risk Score for Sepsis-3 Patients in Intensive Care Unit.

Background: Many severity scores are widely used for clinical outcome prediction for critically ill patients in the intensive care unit (ICU). However, for patients identified by sepsis-3 criteria, none of these have been developed. This study aimed to develop and validate a risk stratification score for mortality prediction in sepsis-3 patients.Methods: In this retrospective cohort study, we employed the Medical Information Mart for Intensive Care III (MIMIC III) database for model development and the eICU database for external validation. We identified septic patients by sepsis-3 criteria on day 1 of ICU entry. The Least Absolute Shrinkage and Selection Operator (LASSO) technique was performed to select predictive variables. We also developed a sepsis mortality prediction model and associated risk stratification score. We then compared model discrimination and calibration with other traditional severity scores.Results: For model development, we enrolled a total of 5,443 patients fulfilling the sepsis-3 criteria. The 30-day mortality was 16.7%. With 5,658 septic patients in the validation set, there were 1,135 deaths (mortality 20.1%). The score had good discrimination in development and validation sets (area under curve: 0.789 and 0.765). In the validation set, the calibration slope was 0.862, and the Brier value was 0.140. In the development dataset, the score divided patients according to mortality risk of low (3.2%), moderate (12.4%), high (30.7%), and very high (68.1%). The corresponding mortality in the validation dataset was 2.8, 10.5, 21.1, and 51.2%. As shown by the decision curve analysis, the score always had a positive net benefit.Conclusion: We observed moderate discrimination and calibration for the score termed Sepsis Mortality Risk Score (SMRS), allowing stratification of patients according to mortality risk. However, we still require further modification and external validation.

A Novel INCNS Score for Prediction of Mortality and Functional Outcome of Comatose Patients.

Objectives: The purpose of this study was to verify the veracity and reliability of the INCNS score for prediction of neurological ICU (NICU) mortality and 3-month functional outcome and mortality in comatose patients.Methods: In this prospective study, data of the patients admitted to NICU from January 2013 to January 2019 were collected for validation. The 3-month functional outcomes were evaluated using modified Rankin Scale (mRS). By using the receiver operating characteristics curve (ROC) analysis, we compared the INCNS score with Glasgow Coma Scale (GCS), Full Outline of Un-Responsiveness Score (FOUR) and Acute Physiology and Chronic Health Evaluation II (APACHE II) for assessment of the predictive performance of these scales for 3-month functional outcome and mortality and NICU mortality performed at 24- and 72-h after admission to the NICU.Results: Totally 271 patients were used for evaluation; the INCNS score achieved an AUC (area under the receiver operating characteristic curve) of 0.766 (95% CI: 0.711–0.815) and 0.824 (95% CI: 0.774–0.868) for unfavorable functional outcomes, an AUC of 0.848 (95% CI: 0.800–0.889) and 0.892 (95% CI: 0.848–0.926) for NICU mortality, and an AUC of 0.811 (95% CI: 0.760–0.856) and 0.832 (95% CI: 0.782–0.874) for the 3-month mortality after discharge from the NICU at 24- and 72-h. The INCNS score exhibited a significantly better predictive performance of mortality and 3-month functional outcomes than FOUR and GCS. There was no significant difference in predicting NICU mortality and 3-month functional outcomes between INCNS and APACHE II, but INCNS had better predictive performance of 3-month mortality than APACHE II.Conclusions: The INCNS score could be used for predicting the functional outcomes and mortality rate of comatose patients.

Spanish Influenza Score (SIS): Usefulness of machine learning in the development of an early mortality prediction score in severe influenza

ObjectiveTo develop a mortality prediction score (Spanish Influenza Score [SIS]) for patients with severe influenza considering only variables at ICU admission, and compare its performance against the APACHE II, SOFA and Random Forest (RF). DesignSub-analysis from the GETGAG / SEMICYUC database ScopeIntensive Care Medicine. PatientsPatients admitted to 184 Spanish ICUs (2009–2018) with influenza infection. InterventionNone. VariablesDemographic data, severity of illness, times from symptoms onset until hospital admission (Gap-H), hospital to ICU (Gap-ICU) or hospital to diagnosis (Gap-Dg), antiviral vaccination, number of quadrants infiltrated, acute renal failure, invasive or noninvasive ventilation, shock and comorbidities. The study variable cut-off points and importance were obtained automatically. Logistic regression analysis with cross-validation was performed to develop the SIS score using the output coefficients. Accuracy and discrimination (AUC-ROC) were applied to evaluate SIS, APACHE, SOFA and RF. All analyses were performed using R (CRAN-R Project). ResultsA total of 3959 patients were included. The mean age was 55 years (range 43−67), 60% were men, APACHE II 16 (12−21) and SOFA 5 (4−8), with ICU mortality 21.3%. Mechanical ventilation, shock, APACHE II, SOFA, acute renal failure and Gap-ICU were included in the SIS. The latter was generated according to the ORs obtained by logistic regression, and showed an accuracy of 83% with an AUC-ROC of 82%, which is superior to APACHE (AUC-ROC 67%) and SOFA (AUC-ROC 71%), but similar to RF (AUC-ROC 82%). ConclusionsThe SIS score is easy to apply and shows adequate capacity to stratify the risk of ICU mortality. However, further studies are needed to validate the tool prospectively.

Development and validation of a laboratory risk score for the early prediction of COVID-19 severity and in-hospital mortality

Background and aimsCoronavirus Disease 2019 is characterized by a spectrum of clinical severity. This study aimed to develop a laboratory score system to identify high-risk individuals, to validate this score in a separate cohort, and to test its accuracy in the prediction of in-hospital mortality. MethodsIn this cohort study, biological data from 330 SARS-CoV-2 infected patients were used to develop a risk score to predict progression toward severity. In a second stage, data from 240 additional COVID-19 patients were used to validate this score. Accuracy of the score was measured by the area under the receiver operating characteristic curve (AUC). ResultsIn the development cohort, a step-wise decrease in the average survival duration was noted with the increment of the risk score (pANOVA < 0.0001). A similar trend was confirmed when analyzing this association in the validation cohort (p < 0.0001). The AUC was 0.74 [0.66–0.82] and 0.90 [0.87–0.94], p < 0.0001, respectively for severity and mortality prediction. ConclusionThis study provides a useful risk score based on biological routine parameters assessed at the time of admission, which has proven its effectiveness in predicting both severity and short-term mortality of COVID-19. Improved predictive scores may be generated by including other clinical and radiological features.

Using CHADS2, R2CHADS2, CHA2DS2-VASc score for mortality prediction in patients with abnormal low and high ankle-brachial index

Abnormal low and high ankle brachial index (ABI) is regarded as peripheral artery disease (PAD) which has extremely high morbidity and mortality. How to identify high-risk PAD patients with increased mortality is very important to improve the outcome. CHADS2, R2CHADS2, and CHA2DS2-VASc score are clinically useful scores to evaluate the annual risk of stroke in patients with atrial fibrillation. However, there was no literature discussing the usefulness of these scores for cardiovascular (CV) and all-cause mortality prediction in the patients with abnormal ABI. This longitudinal study enrolled 195 patients with abnormal low (< 0.9) and high ABI (> 1.3). CHADS2, R2CHADS2, and CHA2DS2-VASc score were calculated for each patient. CV and all-cause mortality data were collected for outcome prediction. The median follow-up to mortality was 90 months. After multivariate analysis, CHADS2, R2CHADS2, and CHA2DS2-VASc score were significant predictors of CV and all-cause mortality (all P < 0.001). CHA2DS2-VASc score had a better additive predictive value than CHADS2 and R2CHADS2 score for CV mortality prediction. R2CHADS2 and CHA2DS2-VASc score had better additive predictive values than CHADS2 score for all-cause mortality prediction. In conclusion, our study is the first study to investigate the usefulness of CHADS2, R2CHADS2, and CHA2DS2-VASc score for mortality prediction in patients with abnormal ABI. Our study showed all three scores are significant predictors for CV and all-cause mortality although there are some differences between the scores. Therefore, using the three scoring systems may help physicians to identify the high-risk PAD patients with increased mortality.

Malaria Severity Score in Malaria Patients Admitted in Critical Care Wards

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI &amp; RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (&gt;18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and non-survivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value &lt;0.05 was considered as significant. Results: Out of 60 patients, 41 survived and 19 died due to malaria. Mean age of survivors was 38.56±2.27 and of non-survivors 40.21±5.6 years (p=0.718). There were 27 patients of P.vivax, 30 of P. falciparum and three patients of mixed infection; mortality was in 09, 08, 02 patients, respectively. On admission, out of total 60 patients, 10 (16.67%) had 1+, 20 (33.33%) had 2+, 24 (40%) had 3+ and 6 (10%) had 4+ parasite count. There were no patients in 1+ parasite count group, two (10%) in 2+, eleven (45.8%) in 3+ and six (100%) in 4+ parasite count group. Mean MSS was not significantly different on day 0 and day 2 but was higher on day 7 in non-survivor group than in survivors group (p=0.005). Mortality prediction score cut-off was ≥9, which was obtained by plotting Receiver Operating Characteristic (ROC) curve. Mean MSS in non-survivor group was 7.37 on day 0, 6.58 on day 2 and 9.11 on day 7. Thus, MSS score of day 7 gave `prediction reaching cut-off value of ≥9. Conclusion: MSS was found to be a useful prognostic score in severe falciparum/vivax malaria who needs intensive care treatment as sequential score gives significant difference in survivors and non-survivors on seventh day.

Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection.

The German Registry of Acute Aortic Dissection Type A (GERAADA) score to predict 30-day mortality in patients suffering from acute aortic dissection type A (AADA) was recently introduced. The aim of this study was to evaluate if the GERAADA score's prediction corresponds with the authors' institutional results. All consecutive AADA patients between 2010 and 2020 were included. Retrospective data collection comprised 11 preoperative parameters: age, sex, previous cardiac surgery, inotropic support at referral, resuscitation before surgery, aortic regurgitation, preoperative hemiparesis, intubation/ventilation at referral, preoperative organ malperfusion, extension of aortic dissection and location of primary entry site. Calculations of the GERAADA score were individually performed by a cardiac surgeon blinded to the study for all patients via a web-based application (https://www.dgthg.de/de/GERAADA_Score). A total of 371 AADA patients were operated at the authors' institution. The mean age was 62.7 ± 13.5 years and 233 (63%) were males. Prediction of 30-day mortality was accurate for the entire study cohort (actual vs predicted 30-day mortality: 15.1% vs 15.7%; P = 0.776) as well as for all 26 subgroups. In addition, preoperative resuscitation (P < 0.001), advanced age (P = 0.042) and other/unknown malperfusion (P = 0.032) were identified as independent risk factors. The GERAADA score prediction of 30-day mortality after surgery is accurate, easily accessible due to its web-based platform and can be calculated with very basic preoperative clinical parameters. A prospective clinical trial is required to further evaluate the new GERAADA score as a useful tool to allow for improved decision-making in the emergency setting of AADA.

Comparison between estimated and brachial-ankle pulse wave velocity for cardiovascular and overall mortality prediction.

Pulse wave velocity (PWV) was a good marker of arterial stiffness and could predict cardiovascular (CV) outcomes. Recently, estimated PWV (ePWV) calculated by equations using age and mean blood pressure was reported to be an independent predictor of major CV events. However, there was no study comparing ePWV with brachial‐ankle PWV (baPWV) for CV and overall mortality prediction. We included 881 patients arranged for echocardiographic examination. BaPWV and blood pressures were measured by ankle‐brachial index‐form device. The median follow‐up period to mortality was 94 months. Mortality events were documented during the follow‐up period, including CV mortality (n = 66) and overall mortality (n = 184). Both of ePWV and baPWV were associated with increased CV and overall mortality after the multivariable analysis. ePWV had better predictive value than Framingham risk score (FRS) for CV and overall mortality prediction, but baPWV did not. In direct comparison of multivariable analysis using FRS as basic model, ePWV had a superior additive predictive value for CV mortality than baPWV (p = .030), but similar predictive valve for overall mortality as baPWV (p = .540). In conclusion, both ePWV and baPWV were independent predictors for long‐term CV and overall mortality in univariable and multivariable analysis. Besides, ePWV had a better additive predictive value for CV mortality than baPWV and similar predictive value for overall mortality as baPWV. Therefore, ePWV obtained without equipment deserved to be calculated for overall mortality prediction and better CV survival prediction.

Direct Bilirubin Is More Valuable than Total Bilirubin for Predicting Prognosis in Patients with Liver Cirrhosis.

Background/AimsMost prognostic prediction models for patients with liver cirrhosis include serum total bilirubin (TB) level as a component. This study investigated prognostic performance of serum direct bilirubin (DB) and developed new DB level-based prediction models for cirrhosis.MethodsA total of 983 hospitalized patients with liver cirrhosis were included. DB-Model for End-Stage Liver Disease (MELD) score was calculated using MELD score formula, with serum DB level replacing TB level.ResultsMean age of study population was 56.1 years. Alcoholic liver disease was the most frequent underlying condition (471 patients, 47.9%). Within 6 months, 144 patients (14.6%) died or received liver transplantation due to severe liver dysfunction. The area under the receiver operating characteristic curve (AUROC) for prediction of 6-month mortality with DB level was significantly higher than that with TB level (p<0.001). The AUROC of DB-MELD score for prediction of 6-month mortality was significantly higher than that of MELD score (p<0.001). Patients were randomly divided into training (n=492) and validation (n=491) cohorts. A new prognostic prediction model, “Direct Bilirubin, INR, and Creatinine” (DiBIC) score, was developed based on the most significant predictors of 6-month mortality. In training set, AUROC of DiBIC score for prediction of 6-month mortality was 0.892, which was significantly higher than that of the MELD score (0.875, p=0.017), but not different from that of DB-MELD score (0.886, p=0.272). Similar results were observed in validation set.ConclusionsNew prognostic models, DB-MELD and DiBIC scores, have good prognostic performance in liver cirrhosis patients, outperforming other currently available models.