RT Journal Article
SR Electronic
T1 A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: derivation, validation and incorporation into a bedside programme
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1032
OP 1037
DO 10.1136/hrt.2007.128132
VO 94
IS 8
A1 Baggish, A L
A1 Lloyd-Jones, D M
A1 Blatt, J
A1 Richards, A M
A1 Lainchbury, J
A1 O’Donoghue, M
A1 Sakhuja, R
A1 Chen, A A
A1 Januzzi, J L
YR 2008
UL http://heart.bmj.com/content/94/8/1032.abstract
AB Background: Risk stratification for patients with acute dyspnoea is a challenging task. No quantitative tool for mortality prediction among patients with acute dyspnoea is available. Methods: 595 dyspnoeic subjects were enrolled in an emergency department. 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 (×0.3), heart rate (×0.2), blood urea nitrogen (×0.3), New York Heart Association class (×5), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) ⩾986 pg/ml (18 points), systolic blood pressure <100 mm Hg (11 points) and presence of a murmur (11 points). A continuous rise in mortality was seen from 1.7% in the lowest score quintile (n = 118; score ⩽48.5) to 43.1% in the highest quintile (n = 116, score ⩾85.5; p<0.001 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 to 0.85) with similar AUCs in subjects with acutely destabilised heart failure (AUC = 0.73, 95% CI 0.67 to 0.79) and those without (AUC = 0.83, 95% CI 0.77 to 0.85, p for the comparison = NS). The score was validated in a separate population of dyspnoeic patients (AUC = 0.73, 95% CI 0.64 to 0.82; p<0.001) and was incorporated into a computer program suitable for near-patient calculation. Conclusion: A new risk stratification tool for acutely dyspnoeic patients has been derived and validated.