title: Predicting short-term mortality in advanced decompensated heart failure - role of the updated acute decompensated heart failure/N-terminal pro-B-type natriuretic Peptide risk score.
abstract: BACKGROUND
  The first few months after admission are the most vulnerable period in patients with acute decompensated heart failure (ADHF).
  
  
  RESULTS
  We assessed the association of the updated ADHF/N-terminal pro-B-type natriuretic peptide (NT-proBNP) risk score with 90-day and in-hospital mortality in 701 patients admitted with advanced ADHF, defined as severe symptoms of worsening HF, severely depressed left ventricular ejection fraction, and the need for i.v. diuretic and/or inotropic drugs. A total of 15.7% of the patients died within 90 days of admission and 5.2% underwent ventricular assist device (VAD) implantation or urgent heart transplantation (UHT). The C-statistic of the ADHF/NT-proBNP risk score for 90-day mortality was 0.810 (95% CI: 0.769-0.852). Predicted and observed mortality rates were in close agreement. When the composite outcome of death/VAD/UHT at 90 days was considered, the C-statistic decreased to 0.741. During hospitalization, 7.6% of the patients died. The C-statistic for in-hospital mortality was 0.815 (95% CI: 0.761-0.868) and Hosmer-Lemeshow χ(2)=3.71 (P=0.716). The updated ADHF/NT-proBNP risk score outperformed the Acute Decompensated Heart Failure National Registry, the Organized Program to Initiate Lifesaving Treatment in Patients Hospitalized for Heart Failure, and the American Heart Association Get with the Guidelines Program predictive models.
  
  
  CONCLUSIONS
  Updated ADHF/NT-proBNP risk score is a valuable tool for predicting short-term mortality in severe ADHF, outperforming existing inpatient predictive models.
authors.affiliation: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge.
authors.forename: Domenico
authors.initials: D
authors.lastname: Scrutinio
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.forename: Andrea
authors.initials: A
authors.lastname: Passantino
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Luciana
authors.initials: L
authors.lastname: D'Angelo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.forename: Marco Matteo
authors.initials: MM
authors.lastname: Ciccone
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.forename: Ilaria
authors.initials: I
authors.lastname: Dentamaro
authors.forename: Daniela
authors.initials: D
authors.lastname: Santoro
authors.forename: Rocco
authors.initials: R
authors.lastname: Lagioia
authors.forename: Simona
authors.initials: S
authors.lastname: Sarzi Braga
authors.forename: Daniela
authors.initials: D
authors.lastname: Guzzetti
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012042:Registries; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain