title: New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: evaluation of the APACHE II and Modified APACHE II scoring systems.
abstract: BACKGROUND
  No scoring system for assessing acute heart failure (AHF) has been reported.
  
  
  RESULTS
  Data for 824 AHF patients were analyzed. The subjects were divided into an alive (n=750) and a dead group (n=74). We constructed a predictive scoring system based on eight significant APACHE II factors in the alive group [mean arterial pressure (MAP), pulse, sodium, potassium, hematocrit, creatinine, age, and Glasgow Coma Scale (GCS); giving each one point], defined as the APACHE-HF score. The patients were assigned to five groups by the APACHE-HF score [Group 1: point 0 (n=70), Group 2: points 1 and 2 (n=343), Group 3: points 3 and 4 (n=294), Group 4: points 5 and 6 (n=106), and Group 5: points 7 and 8 (n=11)]. A higher optimal balance was observed in the APACHE-HF between sensitivity and specificity [87.8%, 63.9%; area under the curve (AUC)=0.779] at 2.5 points than in the APACHE II (47.3%, 67.3%; AUC=0.558) at 17.5 points. The multivariate Cox regression model identified belonging to Group 5 [hazard ratio (HR): 7.764, 95% confidence interval (CI) 1.586-38.009], Group 4 (HR: 6.903, 95%CI 1.940-24.568) or Group 3 (HR: 5.335, 95%CI 1.582-17.994) to be an independent predictor of 3-year mortality. The Kaplan-Meier curves revealed a poorer prognosis, including all-cause death and HF events (death, readmission-HF), in Group 5 and Group 4 than in the other groups, in Group 3 than in Group 2 or Group 1, and in Group 2 than in Group 1.
  
  
  CONCLUSIONS
  The new scoring system including MAP, pulse, sodium, potassium, hematocrit, creatinine, age, and GCS (APACHE-HF) can be used to predict adverse outcomes of AHF.
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Hirotake
authors.initials: H
authors.lastname: Okazaki
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan. Electronic address: s6042@nms.ac.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shirakabe
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shinada
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Tsurumi
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D015600:Glasgow Coma Scale; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011379:Prognosis; D012680:Sensitivity and Specificity
keywords: Acute heart failure syndrome; Mortality; Prognosis; Scoring