A Clinical and Biochemical Score for Mortality Prediction in Patients with Acute Dyspnea: Derivation, Validation, and Incorporation into a Bedside Program

Aaron L Baggish ^1*, Donald M Lloyd ², Jacob Blatt ³, A Mark Richards ⁴, John Lainchbury ⁴, Michelle O'Donoghue ¹, Rahul Sakhuja ¹, Annabel A Chen ¹ and James L Januzzi Jr.¹

¹ Massachusetts General Hospital, United States
² Northwestern University Feinberg School of Medicine, United States
³ Emory University School of Medicine, United States
⁴ Cardioendocrine Research Group, Christchurch Hospital, New Zealand

^* To whom correspondence should be addressed. E-mail: abaggish{at}partners.org.

Accepted 11 September 2007

Abstract

Background Risk stratification for patients with acute dyspnea is a challenging task. No quantitative tool for mortality prediction among patients with acute dyspnea is available.

Methods 595 dyspneic subjects were enrolled in an ED. Clinical and biochemical factors independently predictive of death by 1-year were used to develop a mortality risk prediction tool.

Results Seven factors comprised the final tool: age (x 0.3), heart rate (x 0.2), blood urea nitrogen (x 0.3), New York Heart Association class (x 5), amino-terminal pro-b type natriuretic peptide (NT-proBNP) i 986 pg/mL (18 points), systolic blood pressure < 100 mmHg (11 points), and presence of a murmur (11 points). There was a continuous rise in observed mortality from 1.7% in the lowest score quintile (n=118; score iÜ 48.5) to 43.1% in the highest quintile (n=116, score i 85.5; P <.001 for trend). Receiver operating characteristic curve analysis of the score's accuracy produced an area under the curve (AUC) of 0.82 (95% CI= 0.78-0.85) with similar AUCs in subjects with ADHF (AUC=0.73, 95% CI=0.67-0.79) and those without (AUC=0.83, 95% CI=0.77-0.85, P for the comparison=NS). The score was validated in a separate population of dyspneic patients (AUC=0.73, 95% CI=0.64-0.82; P <.001) and was incorporated into a computer program suitable for near-patient calculation.

Conclusion We report the derivation and validated of a novel risk stratification tool for acutely dyspneic patients.

Keywords: acute decompensated heart failure, mortality, natriuretic peptides, risk score

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