Risk Score of Swartz et al for Predicting Mortality in a Patient with a Mechanical Device While Awaiting Cardiac Transplantation

Description

Swartz et al developed a score for evaluating a patient with a mechanical cardiac device pending a heart transplant. This can help identify a patient who may be at greater risk for death while awaiting a donor to become available. The authors are from St Louis University in St Louis, Missouri.

Patient selection: requires a heart transplant, awaiting a donor

Outcome: survival to hospital discharge

Inclusion criteria:

(1) cardiac index < 2.0 L per min per square meter

(2) systemic mean arterial pressure < 65 mm Hg

(3) pulmonary capillary wedge pressure > 18 mm Hg

(4) may have up to 2 inotropic drugs at high doses or 1 inotropic plus intra-aortic balloon support (see page 1143).

Exclusion criteria"

(1) renal failure with BUN > 100 mg/dL and/or creatinine > 5 mg/dL

(2) severe peripheral artery disease

(3) symptomatic cerebrovascular disease

(4) cancer with metastases

(5) severe liver disease

(6) severe coagulopathy

(7) severe infection resistant to therapy

Parameters:

(1) age

(2) gender

(3) hospital

(4) inotropic drug duration

(5) intubation

(6) required FIO2

(7) intra-aortic balloon

(8) cardiac index

(9) cardiac arrest within 24 hours

(10) cardiac arrest requiring ECMO

(11) recent cardiac surgery

(12) bacteremia

(13) fever

(14) white blood cell count (WBC)

(15) serum BUN

(16) serum creatinine

(17) urine output

(18) platelet count

(19) hematocrit

(20) aPTT

(21) serum albumin

Parameter	Finding	Points
age of the patient in years	< 50 years of age	0
	50 to 55 years of age	1
	> 55 years of age	2
gender	male	0
	female	1
hospital course prior to device	able to stabilize	0
	unable to stabilize (requires device in < 1 day after admission)	2
inotropic drug use	< 5 days	0
	>= 5 days	1
intubation status	not intubated	0
	intubated < 5 days	1
	intubated >= 5 days	2
FIO2 required	<= 0.70	0
	> 0.70	2
intra-aortic balloon	none	0
	0 to 4 days	1
	>= 5 days	2
cardiac index	>= 2 L per min per square meter	0
	< 2 L per min per square meter	1
cardiac arrest	none	0
	within 24 hours	2
	more than 24 hours	0
need for ECMO after cardiac arrest	none	0
	present	3
cardiac operation	none	0
	within past 10 days	2
	more than 10 days ago	0
bacteremia	absent	0
	present	2
fever > 38.9°C	within past 24 hours	2
	not within past 24 hours	0
white blood cell count	<= 15,000 per µL	0
	> 15,000 per µL	1
BUN	<= 60 mg/dL	0
	> 60 mg/dL (> 100 an exclusion)	2
serum creatinine	<= 2.2 mg/dL	0
	> 2.2 mg/dL (> 5 an exclusion)	3
urine output in past 4 hours	>= 120 mL	0
	< 120 mL	2
platelet count	>= 100,000 per µL	0
	< 100,000 per µL	1
hematocrit	>= 30%	0
	< 30%	1
aPTT	< 75 seconds	0
	75 - 100 seconds	1
	> 100 seconds	2
serum albumin	>= 2.5 g/dL	0
	< 2.5 g/dL	1

total score =

= SUM(points for all 21 parameters)

Interpretation:

• minimum score: 1 (the cardiac index < 2 is an inclusion criteria)

• maximum score: 37

• The higher the score the greater the risk of death.

Total Score	Risk Group
< 5	low risk
5 - 10	moderate risk
> 10	high risk

Limitation:

• The methods and reference intervals for the laboratory tests are not given.

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Description

Specialty

ICD-10