Falsetti Lorenzo, Zaccone Vincenzo, Guerrieri Emanuele, Perrotta Giulio, Diblasi Ilaria, Giuliani Luca, Palma Linda Elena Gialluca, Viticchi Giovanna, Fioranelli Agnese, Moroncini Gianluca, Pansoni Adolfo, Luccarini Marinella, Martino Marianna, Scalpelli Caterina, Burattini Maurizio, Tarquinio Nicola
Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, 60100 Ancona, Italy.
Emergency Medicine Residency Program, Marche Polytechnic University, 60100 Ancona, Italy.
J Clin Med. 2022 May 25;11(11):2982. doi: 10.3390/jcm11112982.
Acute heart failure (AHF) is a cardiac emergency with an increasing incidence, especially among elderly patients. The Emergency Heart failure Mortality Risk Grade (EHMRG) has been validated to assess the 7-days AHF mortality risk, suggesting the management of patients admitted to an emergency department (ED). EHMRG has never been implemented in Italian ED nor among elderly patients. We aimed to assess EHMRG score accuracy in predicting in-hospital death in a retrospective cohort of elderly subjects admitted for AHF from the ED to an Internal Medicine Department. We enrolled, in a 24-months timeframe, all the patients admitted to an Internal Medicine Department from ED for AHF. We calculated the EHMRG score, subdividing patients into six categories, and assessing in-hospital mortality and length of stay. We evaluated EHMRG accuracy with ROC curve analysis and survival with Kaplan−Meier and Cox models. We collected 439 subjects, with 45 in-hospital deaths (10.3%), observing a significant increase of in-hospital death along with EHMRG class, from 0% (class 1) to 7.7% (class 5b; p < 0.0001). EHMRG was fairly accurate in the whole cohort (AUC: 0.75; 95%CI: 0.68−0.83; p < 0.0001), with the best cutoff observed at >103 (Se: 71.1%; Sp: 72.8%; LR+: 2.62; LR-: 0.40; PPV: 23.0%; NPV: 95.7%), but performed better considering the events in the first seven days of admission (AUC: 0.83; 95%; CI: 0.75−0.91; p < 0.0001). In light of our observations, EHMRG can be useful also for the Italian emergency system to predict the risk of short-term mortality for AHF among elderly patients. EHMRG performance was better in the first seven days but remained acceptable when considering the whole period of hospitalization.
急性心力衰竭（AHF）是一种发病率不断上升的心脏急症，在老年患者中尤为常见。急诊心力衰竭死亡率风险分级（EHMRG）已被验证可用于评估AHF患者7天的死亡风险，为急诊科（ED）收治的患者管理提供了参考。EHMRG从未在意大利的急诊科实施过，也未在老年患者中应用过。我们旨在评估EHMRG评分在预测从急诊科收治到内科的老年AHF患者住院死亡方面的准确性。在24个月的时间范围内，我们纳入了所有从急诊科收治到内科的AHF患者。我们计算了EHMRG评分，将患者分为六类，并评估了住院死亡率和住院时间。我们通过ROC曲线分析评估EHMRG的准确性，并使用Kaplan-Meier和Cox模型评估生存率。我们收集了439名受试者，其中45人在住院期间死亡（10.3%），观察到随着EHMRG分级的增加，住院死亡率显著上升，从0%（1级）到7.7%（5b级；p<0.0001）。EHMRG在整个队列中相当准确（AUC：0.75；95%CI：0.68−0.83；p<0.0001），最佳截断值为>103（敏感性：71.1%；特异性：72.8%；阳性似然比：2.62；阴性似然比：0.40；阳性预测值：23.0%；阴性预测值：95.7%），但在入院的前七天考虑事件时表现更好（AUC：0.83；95%；CI：0.75−0.91；p<0.0001）。根据我们的观察结果，EHMRG对于意大利的应急系统预测老年AHF患者的短期死亡风险也可能有用。EHMRG在前七天的表现更好，但在考虑整个住院期间时仍然可以接受。
