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.
Specialty: Critical Care, Emergency Medicine, Surgery, general, Cardiology
ICD-10: ,