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A Clinical and Biochemical Score for Mortality Prediction in Patients with Acute Dyspnea: Derivation, Validation, and Incorporation into a Bedside Program
  1. Aaron L Baggish (abaggish{at}partners.org)
  1. Massachusetts General Hospital, United States
    1. Donald M Lloyd (dljone{at}northwestern.edu)
    1. Northwestern University Feinberg School of Medicine, United States
      1. Jacob Blatt (jblatt{at}emory.edu)
      1. Emory University School of Medicine, United States
        1. A Mark Richards (mark.richards{at}cdhb.govt.nz)
        1. Cardioendocrine Research Group, Christchurch Hospital, New Zealand
          1. John Lainchbury (john.lainchbury{at}cdhb.govt.nz)
          1. Cardioendocrine Research Group, Christchurch Hospital, New Zealand
            1. Michelle O'Donoghue (modonoghue{at}partners.org)
            1. Massachusetts General Hospital, United States
              1. Rahul Sakhuja (rsakhuja{at}partners.org)
              1. Massachusetts General Hospital, United States
                1. Annabel A Chen (achen{at}partners.org)
                1. Massachusetts General Hospital, United States
                  1. James L Januzzi, Jr. (jjanuzzi{at}partners.org)
                  1. Massachusetts General Hospital, United States

                    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) iÝ 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 iÝ 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.

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