Severe heart failure at intensive therapy unit--is there an ideal prognostic index?
OBJECTIVE
To assess the applicability of three prognostic indexes--APACHE II, SAPS II and UNICAMP II--in a subgroup of critical heart failure (HF) patients.


METHODS
Ninety patients were studied, being 12 females and 78 males. Mean age was 56 (18-83). Patients were ranked in functional class IV (NYHA) or cardiogenic shock secondary to cardiomyopathies: dilated (44%), chagasic (25.5%), ischemic (18%), hypertensive (1.1%), hypertrophic (1.1%), alcoholic (1.1%), and secondary to valvopathies after surgical correction (7.7%). Tables with frequency of categorical variables and descriptive statistics of continuous variables were created in order to describe sample profile for the different variables under study. In order to analyze the relationship between prognostic indexes levels and course towards death, an analysis of the ROC curve, as well as Hosmer and Lemeshow Test of Goodness of Fit calculated, and Standardized Mortality Ratio (SMR) were carried out.


RESULTS
The statistical analysis showed low sensitivity, specificity, and accuracy of the three prognostic indexes for HF patients. Mortality was underestimated in this group. Pulmonary thromboembolism (PTE) was a major factor of mortality rate in severe HF.


CONCLUSIONS
The three prognostic indexes under study did not prove to be appropriate for the assessment of cardiopathy patients at Intensive Care Unit (ICU). For HF patients, PTE played a major role in mortality of heart failure. Specific prognostic indexes for cardiopathy patients with severe HF should be proposed, and the discussion on anticoagulation on those patients should be expanded.
Terzi
Cristina Bueno
CB
Instituto do Coração do Hospital das Clínicas da FMUSP e Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brazil.
Lage
Silvia G
SG
Dragosavac
Desanka
D
Terzi
Renato G G
RG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality*; D016638:Critical Illness / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index