Silesian Center for Heart Diseases, Zabrze, Poland
Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
Pol Arch Intern Med. 2024 Aug 8;134(7-8). doi: 10.20452/pamw.16757. Epub 2024 May 24.
Accurate risk assessment in patients with heart failure (HF) is crucial. Developing new models that combine biochemical and clinical variables with novel biomarkers is the best approach to improving the management and prognostic evaluation in this population.
We aimed to assess and compare the predictive utility of a new prognostic scale, the Barcelona Bio‑Heart Failure (BCN Bio‑HF) risk calculator, as well as traditional risk scores, the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM), in patients with end‑stage HF. We also searched for other risk factors associated with worse prognosis in the analyzed population.
This was a prospective analysis of 279 patients with end‑stage HF listed for heart transplant between 2018 and 2021. The BCN Bio‑HF, HFSS, and SHFM scores were calculated in all patients, and the accuracy of these 3 models for predicting 1‑year mortality was assessed using receiver operating characteristic (ROC) analysis.
Median (interquartile range) age of the patients was 56 (50-60) years, and 87.1% of the study population were men. During 1‑year follow‑up, a total of 95 patients (34.1%) died. The areas under the ROC curves for predicting 1‑year mortality were 0.95 (95% CI, 0.92-0.97) for BCN Bio‑HF, 0.81 (95% CI, 0.76-0.86) for HFSS, and 0.7 (95% CI, 0.63-0.76) for SHFM. We found that the BCN Bio‑HF (hazard ratio [HR], 1.015; 95% CI, 1.012-1.019; P <0.001) and HFSS scores (HR, 2.801; 95% CI, 1.848-4.237; P <0.001), along with the circulating bilirubin concentration (HR, 1.015; 95% CI, 1.002-1.028; P = 0.02), were associated with 1‑year mortality in the analyzed population.
The BCN Bio‑HF risk score had significantly better prognostic performance than HFSS or SHFM. Lower BCN and HFSS scores and a higher bilirubin concentration were independently associated with a higher risk of 1‑year death in patients with end‑stage HF.
准确评估心力衰竭（HF）患者的风险至关重要。开发将生化和临床变量与新型生物标志物相结合的新模型是改善该人群管理和预后评估的最佳方法。
我们旨在评估和比较一种新的预后评分——巴塞罗那生物心力衰竭（BCN Bio-HF）风险计算器，以及传统风险评分——心力衰竭生存评分（HFSS）和西雅图心力衰竭模型（SHFM）在终末期 HF 患者中的预测效用。我们还在分析人群中寻找与预后较差相关的其他危险因素。
这是一项对 2018 年至 2021 年期间接受心脏移植的 279 例终末期 HF 患者的前瞻性分析。对所有患者计算 BCN Bio-HF、HFSS 和 SHFM 评分，并使用接收者操作特征（ROC）分析评估这 3 种模型预测 1 年死亡率的准确性。
患者的中位（四分位距）年龄为 56（50-60）岁，87.1%的研究人群为男性。在 1 年随访期间，共有 95 例患者（34.1%）死亡。BCN Bio-HF、HFSS 和 SHFM 预测 1 年死亡率的 ROC 曲线下面积分别为 0.95（95%CI，0.92-0.97）、0.81（95%CI，0.76-0.86）和 0.7（95%CI，0.63-0.76）。我们发现 BCN Bio-HF（危险比[HR]，1.015；95%CI，1.012-1.019；P<0.001）和 HFSS 评分（HR，2.801；95%CI，1.848-4.237；P<0.001），以及循环胆红素浓度（HR，1.015；95%CI，1.002-1.028；P=0.02）与分析人群的 1 年死亡率相关。
BCN Bio-HF 风险评分具有显著更好的预后性能，优于 HFSS 或 SHFM。较低的 BCN 和 HFSS 评分以及较高的胆红素浓度与终末期 HF 患者 1 年死亡风险增加独立相关。
