New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems

BackgroundNo scoring system for assessing acute heart failure (AHF) has been reported.Methods and resultsData for 824 AHF patients were analyzed. The subjects were divided into an alive (n = 750) and a dead group (n = 74). We constructed a predictive scoring system based on eight significant APACHE II factors in the alive group [mean arterial pressure (MAP), pulse, sodium, potassium, hematocrit, creatinine, age, and Glasgow Coma Scale (GCS); giving each one point], defined as the APACHE-HF score. The patients were assigned to five groups by the APACHE-HF score [Group 1: point 0 (n = 70), Group 2: points 1 and 2 (n = 343), Group 3: points 3 and 4 (n = 294), Group 4: points 5 and 6 (n = 106), and Group 5: points 7 and 8 (n = 11)]. A higher optimal balance was observed in the APACHE-HF between sensitivity and specificity [87.8%, 63.9%; area under the curve (AUC) = 0.779] at 2.5 points than in the APACHE II (47.3%, 67.3%; AUC = 0.558) at 17.5 points. The multivariate Cox regression model identified belonging to Group 5 [hazard ratio (HR): 7.764, 95% confidence interval (CI) 1.586–38.009], Group 4 (HR: 6.903, 95%CI 1.940–24.568) or Group 3 (HR: 5.335, 95%CI 1.582–17.994) to be an independent predictor of 3-year mortality. The Kaplan–Meier curves revealed a poorer prognosis, including all-cause death and HF events (death, readmission-HF), in Group 5 and Group 4 than in the other groups, in Group 3 than in Group 2 or Group 1, and in Group 2 than in Group 1.ConclusionsThe new scoring system including MAP, pulse, sodium, potassium, hematocrit, creatinine, age, and GCS (APACHE-HF) can be used to predict adverse outcomes of AHF.