title: The PROTECT in-hospital risk model: 7-day outcome in patients hospitalized with acute heart failure and renal dysfunction.
abstract: OBJECTIVE
  In patients with acute heart failure (AHF), early worsening heart failure (WHF) predicts a significant proportion of post-discharge readmissions and mortality. We aimed to identify the predictors of 7-day heart failure events or death in patients hospitalized with AHF.
  
  
  RESULTS
  A predictive model and risk score for the short-term primary composite endpoint of 7-day death, HF rehospitalization, or WHF was created using variables collected within 24 h of admission from patients with complete data (n = 2015) enrolled in the PROTECT trial of AHF patients. The 7-day composite was experienced by 294 patients (14.6%), with a mortality rate of 1.8% (n = 37), HF rehospitalization rate of 0.5% (n = 9), and WHF rate of 13.1% (n = 264). In multivariable analyses, the strongest predictor of short-term morbidity and mortality was higher blood urea nitrogen (BUN) concentration. Additional independent predictors of a worse outcome were lower serum albumin, cholesterol, and systolic blood pressure, as well as higher heart rate and respiratory rate. Model coefficients were converted to an additive risk score for predicting the 7-day composite endpoint with a total point range of 0-100. The risk score allowed discrimination of a wide spectrum of risk (4.8% risk with score ≤35, to 28.7% risk with score >55).
  
  
  CONCLUSIONS
  Using the PROTECT 7-day risk model and score, the main determinants of an adverse outcome for AHF patients included impaired metabolic status, neurohormonal activation, and reduced cardiac performance, gauged by BUN, serum albumin and cholesterol levels, systolic blood pressure, heart rate, and respiratory rate.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. christophe.oconnor@dm.duke.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: John G
authors.initials: JG
authors.lastname: Cleland
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: George A
authors.initials: GA
authors.lastname: Mansoor
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.forename: Karen
authors.initials: K
authors.lastname: Chiswell
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018570:Risk Assessment / Q000379:methods; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States