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Curso de Atualização em Medicina Cardiovascular 2019
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BAUN score, a predictive model of in-hospital mortality in heart failure
Session:
CO7 - Insuficiência Cardíaca
Speaker:
João Miguel Santos
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Miguel Santos; Inês Pires; Luísa Gonçalves; Hugo Da Silva Antunes; Júlio Gil; Luís Abreu; Inês Almeida; Emanuel Correia; José Costa Cabral
Abstract
<p><strong>Introduction</strong></p> <p>Patients hospitalized due to heart failure (HF) compose a heterogeneous population whose prognosis and in-hospital mortality (IHM) are difficult to forecast. The purpose of this study was to create a simple model capable of accurately predicting IHM in these individuals.</p> <p><strong>Methods </strong></p> <p>A retrospective analysis of 1052 patients admitted to a Cardiology ward due to decompensated HF was performed. 141 patients were excluded due to data omission. The variables systolic blood pressure (SBP), urea, brain natriuretic peptide (BNP) and sodium at admission were selected for score inclusion. The Mann-Whitney U and T-test were used for mean comparison between groups. Subgroups were created for each variable. For each subgroup, an <em>odds ratio </em>(OR) for the risk of IHM was calculated, and a numerical value proportional to the OR was subsequently attributed. The reference values for BNP, urea and sodium in healthy individuals were classified with 0 points, as well as an SBP>140 mmHg. A score (BAUN) was created, ranging from 0-28 points, corresponding to the sum of the classification attributed to each variable. A ROC curve analysis was then performed to evaluate the predictive value of the score for IHM.</p> <p><strong>Results</strong></p> <p>Mean patient age was 77 (±10) years; 51% were men. Mean LVEF was 49% (±16,4). A LVEF<40% was present in 31% of patients. IHM was 6.5%. A statistically significant association between IHM and the variables SBP and sodium was found on T-test (p<0.001). The same was verified for BNP and urea in the Mann-Whitney U test (p<0.001). Pearson correlation test did not reveal significant correlation between variables; thus, an independent variation between them was assumed. ROC curve analysis revealed an AUC of 0.752 (p<0.001). The cut-off point with the most sensitivity (S) and specificity (E) obtained using the Youden index (IY=0.3626) was 4 (S≈92% e E≈45%). The analysis of mortality by score interval revealed an IHM of 1.3%, 7.5%, 17.6% e 35%, respectively, for the intervals <5, 5-15, 16-22, >22. A BAUN score>22 predicts death in 1 out of 3 patients hospitalized due to HF. A score <5 predicts a very low risk of IHM (≈1%).</p> <p><strong>Conclusion</strong></p> <p>The BAUN score is a good predictive model of IHM in patients hospitalized due to HF. It is also objective and easy to apply. Its use may help to identify patients with a very high risk of IHM in need of specialized care, and those patients with very low risk of death, who might be candidates for early discharge.</p>
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