1 Heart Center Department of Clinical and Experimental Cardiology Amsterdam Cardiovascular Sciences Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands.
2 Department of Radiology and Nuclear Medicine Radboud University Medical Center Nijmegen the Netherlands.
J Am Heart Assoc. 2019 Jul 16;8(14):e010309. doi: 10.1161/JAHA.118.010309. Epub 2019 Jul 12.
Background Our aim was to calibrate and externally revalidate the ELAN-HF (European Collaboration on Acute Decompensated Heart Failure) score, to confirm and improve on a previous external validation of the risk score. Methods and Results The ELAN-HF score predicts 6-month all-cause mortality in patients hospitalized for acute decompensated heart failure using absolute and percentage change of NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels in addition to clinical variables. For the external validation, we used the PRIMA II (Can NT-proBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?) trial. For both data sets, observed versus predicted mortality was compared for the 4 risk categories; and the mean predicted mortality was plotted against the observed mortality with calculation of a correlation coefficient and SEE. The model discriminant ability was determined by comparing the C-statistics for both data sets. The predicted versus actual 6-month mortality values in the derivation cohort were 3.7% versus 3.6% for the low-risk category, 9.4% versus 9.2% for the intermediate-risk category, 24.2% versus 23.5% for the high-risk category, and 54.2% versus 51.1% for the very-high-risk category. The correlation between predicted and observed mortality by deciles was 0.92, with an SEE of ±4%. In the validation cohort, predicted versus actual 6-month mortality values were 3.0% versus 2.2% for the low-risk category, 9.4% versus 8.2% for the intermediate-risk category, 25.0% versus 22.9% for the high-risk category, and 56.8% versus 53.6% for the very-high-risk category. The correlation between predicted and actual mortality by quintiles was 0.99, with an SEE of ±2%. There was no significant difference in C-statistic between the derivation cohort (0.78; 95% CI, 0.74-0.82) and the validation cohort (0.77; 95% CI, 0.69-0.84; P=0.693). Conclusions Our study confirms that the ELAN-HF score predicts accurately 6-month mortality in patients hospitalized for acute decompensated heart failure with the use of easily obtained characteristics.
我们的目的是校准和外部验证 ELAN-HF（欧洲急性失代偿性心力衰竭合作）评分，以确认和改进该风险评分的先前外部验证。方法和结果：ELAN-HF 评分使用 NT-proBNP（N 端脑利钠肽前体）水平的绝对值和百分比变化以及临床变量来预测因急性失代偿性心力衰竭住院的患者 6 个月全因死亡率。对于外部验证，我们使用了 PRIMA II（Can NT-proBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions？）试验。对于两个数据集，比较了 4 个风险类别中的观察死亡率与预测死亡率；并计算了相关系数和 SEE，将平均预测死亡率与观察死亡率进行比较。通过比较两个数据集的 C 统计量来确定模型判别能力。在推导队列中，预测与实际 6 个月死亡率值在低危组分别为 3.7%与 3.6%，中危组分别为 9.4%与 9.2%，高危组分别为 24.2%与 23.5%，极高危组分别为 54.2%与 51.1%。按十分位数预测与观察死亡率的相关性为 0.92，SEE 为±4%。在验证队列中，预测与实际 6 个月死亡率值在低危组分别为 3.0%与 2.2%，中危组分别为 9.4%与 8.2%，高危组分别为 25.0%与 22.9%，极高危组分别为 56.8%与 53.6%。按五分位预测与实际死亡率的相关性为 0.99，SEE 为±2%。推导队列（0.78；95%CI，0.74-0.82）和验证队列（0.77；95%CI，0.69-0.84；P=0.693）之间的 C 统计量无显著差异。结论：我们的研究证实，ELAN-HF 评分使用易于获得的特征准确预测因急性失代偿性心力衰竭住院的患者 6 个月死亡率。
