SPC365

BAUN score, a better predictive model of in-hospital and long-term outcomes in acute heart failure?

Session: CO 22- Insuficiência cardíaca aguda
Speaker: João Miguel Santos

Congress: CPC 2021
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; Vanda Neto; Joana Correia; Luísa Gonçalves; Inês Almeida; Emanuel Correia
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients hospitalized due to acute heart failure (AHF) compose a heterogeneous population whose prognosis is difficult to forecast. Previously, BAUN score has&nbsp;proven to be able to accurately predict&nbsp;in-hospital mortality (IHM) in AHF. We aimed to evaluate BAUN score performance in the prediction of long-term outcomes in this population, comparing it to&nbsp;the recently validated Get With The Guidelines (GWTG) score.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A retrospective analysis of 1052 patients admitted to a Cardiology ward due to AHF was performed. 268 patients were excluded due to data omission or therapy with sacubitril/valsartan. Using the variables systolic blood pressure, urea, brain natriuretic peptide&nbsp;and sodium at admission, BAUN score was calculated, ranging from 0-28 points. GWTG score was also calculated at the index event. ROC curve analysis was used to compare the predictive value of the two scores for IHM. Kaplan-Meyer and Cox-regression analysis were performed to evaluate BAUN score prediction ability for 24-month mortality (24-MM) and for the composite endpoint of 24-month rehospitalization or death (24-MH).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean patient age was 77 (&plusmn;10) years; 51% were men. Mean left ventricle ejection fraction (EF)&nbsp;was 49% (&plusmn;16.4). An EF&lt;40% was present in 31% of patients. IHM, 24-MM and 24-HM were&nbsp;6.5%, 17.1% and&nbsp;57.8%, respectively. Mean BAUN score was 7 (&plusmn;5.64). Mean GWTG score was 49.7 (&plusmn;9.8). ROC curve analysis for IHM prediction revealed a better performance of the BAUN score (AUC: 0.738, <span style="background-color:white"><span style="color:black">p&lt;0.001) in comparison with GWTG score (AUC: 0.687, p&lt;0.001). Patients were stratified into subgroups according to BAUN risk score &ndash; very-high risk (</span></span><span style="background-color:white"><span style="color:black">&ge;</span></span><span style="background-color:white"><span style="color:black">22), high risk (16-21), intermediate risk (5-15) and low risk (&lt;5). Kaplan-Meyer analysis revealed a significant difference in 24-MM according to risk subgroup (very high: 35%, high: 26.7%, intermediate: 19.5%, low risk: 12.7%, &chi;2=16.304, p=0.001). When stratified by non-reduced or reduced EF (</span></span><span style="background-color:white"><span style="color:black">&ge;</span></span><span style="background-color:white"><span style="color:black">40% or &lt;40%), there was still a significant mortality difference in&nbsp;subgroups with reduced (p=0.007) and borderline significant in patients with non-reduced EF (p=0.05). Kaplan-Meyer analysis also revealed a significant difference between subgroup risk for 24-MH&nbsp;(51%; 63.8%; 63.3% and 75%, respectively, for low, intermediate, high and very-high risk, &chi;2=21.237, p&lt;0.001). Cox regression analysis demonstrated that BAUN score independently predicts 24-MM&nbsp;(HR: 1.056, p=0.043) </span></span></span><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">and 24-MH (HR: 1.033, p=0.048)</span></span></span><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">, even after adjustment for other prognostic markers, such as atrial fibrillation, coronary artery disease, previous myocardial infarction, age, EF and GWTG score. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BAUN outperforms GWTG score for&nbsp;IHM prediction in AHF. It also independently predicts 24-MM and 24-MH. Its use may&nbsp;identify patients with high risk of mortality/readmission, in need of specialized care, and those patients with low risk of death, who might be candidates for lenient surveillance.</span></span></p>