O'Connor et al reported a prognostic score for a patient hospitalized with acute heart failure and mild to moderate renal dysfunction. This is based on the international PROTECT trial. The authors are from Duke University, Momentum Research, University of Brescia, University of Hull, Brigham and Women's Hospital, Merck Research Laboratories, KlinikaKardiologii (Wroclaw), University of California San Francisco, San Francisco Veterans Affairs Medical Center and University Medical Center Groningen.
Patient selection: hospitalized for acute heart failure, with mild or moderate renal impairment
Outcomes: death, worsening heart failure or rehospitalization within 7 days
Parameters:
(1) serum BUN in mg/dL
(2) systolic blood pressure in mm Hg
(3) respiratory rate in breaths per minute
(4) hospitalized in the past year for heart failure
(5) serum albumin in g/dL
(6) heart rate in beats per minute
(7) serum total cholesterol in mg/dL
(8) diabetes mellitus
Parameter
Finding
Points
serum BUN
<= 8
0
8.1 to 16
8
16.1 to 32
16
32.1 to 64
24
64.1 to 128
32
> 128
40
systolic blood pressure
<= 90
12
91 to 100
11
101 to 110
9
111 to 120
8
121 to 130
6
131 to 140
5
141 to 150
3
151 to 160
2
> 160
0
respiratory rate
<= 15
0
16 to 20
2
21 to 25
4
26 to 30
7
> 30
9
hospitalized in past year
no
0
yes
3
serum albumin
<= 2.0
15
2.1 to 2.5
13
2.6 to 3.0
10
3.1 to 3.5
8
3.6 to 4.0
5
4.1 to 4.5
3
> 4.5
0
heart rate
<= 50
0
51 to 60
1
61 to 70
3
71 to 80
4
81 to 90
5
91 to 100
7
101 to 110
8
111 to 120
10
> 120
11
serum cholesterol
<= 120
7
121 to 160
5
161 to 200
4
201 to 240
2
> 240
0
diabetes
no
0
yes
3
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
Total Score
Percent with Outcome
<= 35
5%
36 to 40
7%
41 to 45
10%
46 to 50
13%
51 to 55
18%
>= 56
29%
Performance:
• The area under the ROC curve was 0.67.
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