Development and internal validation of a rapid bedside score for predicting in-hospital mortality in acute heart failure

Table 1 Baseline characteristics of patients with acute heart failure stratified by in-hospital mortality, n (%)/mean ± SD

Variable	Patients (n = 123)	Survivors (n = 103)	Non-survivors (n = 20)	P value
Age (years)	71.34 ± 13.98	70.3 ± 14.34	76.4 ± 10.85	0.039
Male sex	62 (50.4)	52 (50.4)	10 (50)	0.968
Smoking	28 (22.76)	26 (25.24)	2 (10)	0.137
Hypertension	107 (86.99)	91 (88.34)	16 (80)	0.31
Obesity	49 (39.83)	37 (35.92)	12 (60)	0.044
Dyslipidaemia	113 (91.86)	98 (95.14)	15 (75)	0.003
Diabetes mellitus	49 (39.83)	40 (38.83)	9 (45)	0.606
AF/atrial flutter	56 (45.52)	46 (44.66)	10 (50)	0.661
ADHF	100 (81.3)	86 (83.49)	14 (70)	0.157
APE	23 (18.69)	17 (16.51)	6 (30)	0.157
Cardiogenic shock	11 (8.94)	3 (2.91)	8 (40)	< 0.001
Leg oedema	73 (59.34)	58 (56.31)	15 (75)	0.119
Pleural effusion	27 (21.95)	16 (15.53)	11 (55)	< 0.001
Ascites	5 (4.06)	3 (2.91)	2 (10)	0.142
Pulmonary rales	73 (59.34)	56 (54.36)	17 (85)	0.011
Jugular vein distension	56 (45.53)	41 (39.81)	15 (75)	0.003
SaO2	93.2 ± 5.24	93.94 ± 4.16	89.8 ± 8.24	0.04
SBP (mmHg)	142.59 ± 29.54	144.33 ± 27.43	133.6 ± 38.226	0.244
DBP (mmHg)	85.83 ± 16.68	87.84 ± 15.747	75.45 ± 17.91	0.002
Heart rate (bpm)	100.98 ± 28.12	101.5 ± 29.18	98.3 ± 22.32	0.644
LVEF (%)	41.21 ± 16.78	41.15 ± 16.58	41.5 ± 18.23	0.934
Haemoglobin (g/dL)	12.78 ± 2.21	12.87 ± 2.22	12.35 ± 2.19	0.338
eGFR (mL/minute/1.73 m2)	62.98 ± 22.72	64.86 ± 22.23	53.3 ± 23.33	0.037
Blood urea (mg/dL)	56.94 ± 28.51	54.08 ± 27.77	71.38 ± 28.48	0.013
Serum sodium (mmol/L)	137.12 ± 4.6	137.54 ± 4.1	134.95 ± 6.56	0.103
Serum potassium (mmol/L)	4.31 ± 0.73	4.32 ± 0.73	4.25 ± 0.79	0.682
NT-proBNP (pg/mL)	9228.3 ± 9736.4	7569.6 ± 8565.9	17770.8 ± 11093.4	0.001
pH	7.38 ± 0.07	7.39 ± 0.07	7.34 ± 0.06	0.002
PaO2 (mmHg)	65.72 ± 30.14	68.59 ± 31.5	50.95 ± 15.22	< 0.001
PaCO2 (mmHg)	33.47 ± 8.48	32.69 ± 8.54	37.5 ± 7.07	0.011
Lactate (mmol/L)	2.31 ± 1.59	2.11 ± 1.47	3.35 ± 1.83	0.009

AF: Atrial fibrillation; ADHF: Acute decompensated heart failure; APE: Acute pulmonary oedema; SaO₂: Oxygen saturation; BP: Blood pressure; bpm: Beats per minute; LVEF: Left ventricular ejection fraction; eGFR: Estimated glomerular filtration rate; NT-proBNP: N-terminal prohormone of brain natriuretic peptide; PaO₂: Partial pressure of oxygen in arterial blood; PaCO₂: Partial pressure of carbon dioxide in arterial blood; SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Table 2 Penalized multivariable logistic regression model for in-hospital mortality

Variable	β-coefficient	OR	95%CI	P value
Log (NT-proBNP)	0.74	2.10	1.30-3.42	0.002
Lactate (mmol/L)	0.42	1.52	1.10-2.09	0.011
Serum sodium (per mmol/L decrease)	-0.15	0.86	0.77-0.96	0.007
SBP < 100 mmHg (yes vs no)	0.91	2.48	1.18-5.20	0.017
Congestion index (0-4)	0.55	1.73	1.22-2.45	0.002

NT-proBNP: N-terminal prohormone of brain natriuretic peptide; SBP: Systolic blood pressure; OR: Odds ratio.

Table 3 Fast Assessment Score for triage in heart failure bedside score: Predictors, categories and assigned points

Predictor	Category	Points
NT-proBNP (pg/mL)	< 3000	0
	3000-8000	3
	> 8000	5
Lactate (mmol/L)	< 2	0
	2-4	2
	> 4	3
Serum sodium (mmol/L)	≥ 135	0
	130-134	2
	125-129	4
	< 125	6
SBP (mmHg)	≥ 100	0
	< 100	6
Congestion index (0-4)	0	0
	1	4
	2	8
	3	12
	4	16
	Total	36 points

NT-proBNP: N-terminal prohormone of brain natriuretic peptide; SBP: Systolic blood pressure.

Table 4 Observed in-hospital mortality across bedside score risk categories

Risk group	FAST-HF Score range	n	Mortality (%)
Low risk	0-8	39	0.0
Intermediate risk	9-14	40	7.5
High risk	≥ 15	44	38.6

FAST-HF: Fast Assessment Score for triage in heart failure.

Table 5 Comparison of prognostic score performance for in-hospital mortality

Score	AUC	95%CI	P value
FAST-HF	0.867	0.784-0.936	< 0.001
EHMRG	0.720	0.571-0.856	0.012
GWTG-HF	0.619	0.444-0.776	0.085

FAST-HF: Fast Assessment Score for Triage in Heart Failure; EHMRG: Emergency Heart Failure Mortality Risk Grade; GWTG-HF: Get with the Guidelines-Heart Failure; AUC: Area under the curve.