ENCOURAGE Mortality Risk Score of Muller et al for a Patient Undergoing VA-ECMO for Cardiogenic Shock Following Acute Myocardial Infarction

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Muller et al reported the ENCOURAGE score for a patient with cardiogenic shock who is undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). This can help to identify a patient who may benefit from more aggressive management. The authors are from Hopital de la Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris and Universite Pierre et Marie Curie in Paris.

Parameters:

(1) age in years

(2) gender

(3) body mass index (BMI)

(4) Glasgow coma score (GCS)

(5) serum creatinine in µmol/L

(6) serum lactate in mmol/l

(7) prothrombin activity in percent

Parameter	Finding	Points
age in years	<= 60 years of age	0
	> 60 years of age	5
gender	male	0
	female	7
body mass index	<= 25 kg per square m	0
	> 25 kg per square m	6
Glasgow coma score	6 to 15	0
	3 to 5	6
serum creatinine	<= 150 µmol/L	0
	> 150 µmol/L	5
serum lactate	< 2 mmol/L	0
	2 to 8 mmol/L	8
	> 8 mmol/L	11
prothrombin activity	>= 50%	0
	< 50%	5

where:

• Prothrombin activity in percent can be converted to prothrombin time with a dilution curve.

ENCOURAGE score =

= SUM(points for all 7 parameters)

Interpretation:

• minimum score: 0

• maximum score: 45

• The higher the score the worse the outcome, including death in the ICU.

Score	30 Day Mortality
0 to 12	8%
13 to 18	33%
19 to 22	50%
23 to 27	76%
28 to 45	83%

from Figure 1 page 375.

Performance:

• The area under the ROC curve for predicting death in the ICU is 0.84.

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ENCOURAGE Mortality Risk Score of Muller et al for a Patient Undergoing VA-ECMO for Cardiogenic Shock Following Acute Myocardial Infarction

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