Predictors of In-Hospital Mortality in Stroke Patients

Abstract Background: In-hospital mortality is a good indicator to assess the efficacy of stroke care. Identifying the predictors of in-hospital mortality is important to advance the stroke outcome and plan the future strategies of stroke management. Methods: This was a prospective observational study conducted at a tertiary referral center in Sri Lanka to identify the possible predictors of in-hospital mortality. The study included 246 confirmed stroke patients. The diagnosis of stroke was established on the clinical history, examination and neuroimaging. The differentiation of stroke in to haemorrhagic type and ischaemic type was based on the results of computed tomography. In all patients, demographic data, comorbidities, clinical signs (pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure, on admission Glasgow Coma Scale (GCS) score) and imaging findings were recorded. Serum electrolyte test was performed in all stroke patients and hyponatremia was defined as serum Na+ less than 131mmol/l. All patients were followed up throughout their hospital course and the in-hospital mortality was recorded. In hospital mortality was defined as the deaths which occurred due to stroke after 24 hours of hospital admission. Results: The incidence of in-hospital mortality was 11.7% (95% confidence interval 8-16.4). The mean day of in-hospital deaths to occur was 5.9 days (SD±3.8 Min 2 Max 20). According to multivariate logistic regression analysis on admission GCS score (Odds Ratio (OR)-0.71) and haemorrhagic stroke type (OR-5.12) predict the in-hospital mortality. The area under the curve of receiver operating curve drawn for the on admission GCS score was 0.78 with a sensitivity of 96.31% and specificity of 41.38% for a patient presented with the GCS score of <10. Conclusion: On admission GCS and haemorrhagic stroke are independent predictors of in-hospital mortality. Patients with on admission GCS <10 have a moderate predictive ability in predicting the in-hospital mortality. Thus, a special attention should be given to the patients with low GCS score and haemorrhagic strokes for reducing rates of in-hospital mortality.

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The Initial Factors with Strong Predictive Value in Relation to Six-Month Outcome among Patients Operated due to Extra-Axial Hematomas

Diagnostics ◽

10.3390/diagnostics10030174 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174 ◽

Cited By ~ 2

Author(s):

Bartłomiej Kulesza ◽

Jakub Litak ◽

Cezary Grochowski ◽

Adam Nogalski ◽

Radosław Rola

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Prognostic Value ◽

Epidural Hematoma ◽

Brain Injuries ◽

Demographic Data ◽

Traumatic Brain Injuries ◽

Factors Affecting ◽

Craniocerebral Injuries ◽

Gcs Score

Introduction: Traumatic brain injuries (TBI) are a real social problem, with an upward trend worldwide. The most frequent consequence of a traumatic brain injury is extra-axial hemorrhage, i.e., an acute subdural (SDH) and epidural hematoma (EDH). Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries. Nonetheless, there are few studies analyzing factors influencing the prognosis regarding patients undergoing surgery due to acute subdural and epidural hematoma. The aim of this study was to identify the factors which have the strongest prognostic value in relation to the 6-month outcome of the patients undergoing surgery for SDH and EDH. Patients and methods: The study included a group of 128 patients with isolated craniocerebral injuries. Twenty eight patients were operated upon due to EDH, and a group of 100 patients were operated upon due to SDH. The following factors from the groups were analyzed: demographic data, physiological factors, laboratory factors, computed tomography scan characteristics, and time between the trauma and the surgery. All of these factors were correlated in a multivariate analysis with the six-month outcome in the Glasgow outcome scale. Results: The factors with the strongest prognostic value are GCS score, respiration rate, saturation, glycaemia and systolic blood pressure. Conclusion: Initial GCS score, respiratory rate, saturation, glycaemia and systolic blood pressure were the factors with the strongest prognostic value.

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Electrocardiographic Abnormalities in Hospitalized acute Cerebrovascular Events

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i4.48978 ◽

2020 ◽

Vol 38 (4) ◽

pp. 166-171

Author(s):

Abu Saleh Mohammed Sirajum Munir ◽

Quazi Tarikul Islam ◽

Mahmudur Rahman Siddiqui

Keyword(s):

Hospital Mortality ◽

Ischaemic Stroke ◽

Acute Stroke ◽

Haemorrhagic Stroke ◽

Qt Prolongation ◽

Stroke Patients ◽

Ecg Changes ◽

College Hospital ◽

Medical College ◽

St Depression

Background: - Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction or ischaemia. Repolarization and ischemic-like electrocardiographic (ECG) changes observed during acute phase of stroke may cause diagnostic and management dilemmas for the physicians. Aim:- The aim and objective of this study to identify the prevalence of ECG changes in acute stroke patients admitted to medicine units of Dhaka Medical College Hospital. Materials and Method: - This 6-month period observational study was carried out among 100 of acute stroke patients admitted in different medicine wards of Dhaka Medical College Hospital (DMCH). ECG was done in all patients after their admission to hospital within 48 hours of developing their symptoms. Association of various types of ECG changes were identified and observed. Results: - Among 100 patients,55% had ischaemic stroke and 45% had haemorrhagic stroke. 43.63% aged between 61-70 years had ischaemic stroke and 28.28% aged between 61-80 years had haemorrhagic stroke. Female had higher frequency of ischaemic stroke 52.72% and male had higher frequency of haemorrhagic stroke 75.56%. Abnormal ECG found 84.44% in haemorrhagic stroke and 54.54% in ischaemic stroke. Of all abnormal ECG, ST depression is most frequent and 42.22% in haemorrhagic stroke, T inversion is next 20% in ischaemic stroke, AF is present in 18.18% in ischaemic stroke and QT prolongation is found in 17.77% in hemorrhagic stroke. There considerable variation of ECG changes according to CT scan evidence of particular area of brain involvement like ST depression (28.88%) found in gangliothalamic bleed in haemorrhagic stroke, AF is found (16.36%) in insular area involvement in ischaemic stroke, T inversion is more (12.72%) in large MCA territory infarctive stroke and QT prolongation (11.11%) is found in intracerebral haemorrhage including SAH. Predictable early in hospital mortality is associated with AF 37.5% and with QT prolongation 31.25%. Conclusion:- In haemorrhagic stroke the ECG abnormalities were more frequent then in ischaemic stroke. The most common abnormalities were ST depression, T wave inversion, AF and QT prolongation. AF and QT prolongation has association of early in hospital mortality. J Bangladesh Coll Phys Surg 2020; 38(4): 166-171

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The impact of low diastolic blood pressure on 30-day mortality of patients with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1652 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Asano ◽

Y Mitsuhashi ◽

M Sachi ◽

K Wakabayashi ◽

K Yahagi ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Diastolic Blood Pressure ◽

Multivariate Logistic Regression Analysis ◽

Term Outcome ◽

Time Of Admission ◽

The Impact

Abstract Background It is known that low diastolic blood pressure (DBP) is associated with long-term cardiovascular events after acute myocardial infarction (AMI). However, the impact of low diastolic blood pressure on short-term outcome has not yet been well investigated. Methods and results We included 15,208 patients who were hospitalized for AMI and registered in the Tokyo CCU network registry between 2013 and 2016. Thirty-day in-hospital mortality rate was 4.8% (728/15,208). To assess the relationship between DBP at the time of admission and 30-day mortality non-linearly, spline regression model was applied with the stratification of the cohort according to tercile of systolic blood pressure (SBP, low:≤122 mmHg, intermediate:123–148 mmHg, high:≥149 mmHg) and J-curve phenomenon was observed in the low and high SBP groups. In multivariate logistic regression analysis, adjusted odds ratio of the lowest quintile of DBP (≤64 mmHg) was 1.65 (95% CI:1.02–2.66) in low SBP group and 4.55 (95% CI:1.72–12.00) in high SBP group. Conclusion Low DBP was associated with increased 30-day in-hospital mortality rate after AMI even in patients with high SBP. Funding Acknowledgement Type of funding source: None

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A comparative study to assess the effectiveness of foot soak on decreasing blood pressure for hypertension clients with and without hypertensive medication

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.3730 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 25-30

Author(s):

Beautily V ◽

Shanmugi J

Keyword(s):

Blood Pressure ◽

Demographic Data ◽

Clinical Signs ◽

Primary Source ◽

Sampling Technique ◽

Structured Interview ◽

Western World ◽

Hypertensive Patients ◽

Blood Institute ◽

Quasi Experimental

Hypertension is one of the primary source of death and incapacity among grown-ups. Hypertension is an inert issue in numerous individuals as it has a long asymptotic stage. The difficult itself has no clinical signs and indications until organ harm has occurred. Hypertension is the most well-known condition requiring deep-rooted medicate treatment in the western world. The National Heart, Lung and Blood Institute of USA has assessed that half of the individuals with hypertension are unconscious of the condition. The present study aims are to assess the effectiveness of foot soak on decreasing blood pressure for hypertension clients with and without hypertensive medication in a selected community area. The quasi-experimental design was used as a research design. Convenient sampling technique was used to select samples. A semi-structured interview was used to collect demographic data, and the BP chart was used to monitor the blood pressure of the patients. For the patients in the experimental group, foot soak was given. After 20 mins, BP was checked and noted in BP graph. The investigation results show that after the organization foot soak there was a noteworthy decrease in the post-test level of systolic BP and diastolic BP among hypertensive patients with and without hypertensive drug was highly significant at p<0.001 level. Foot soak is the simple and financially savvy approach to decrease pulse among hypertensive patients with and without hypertensive prescription.

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Study of Aetiological and Clinical Profile of Stroke Patients with Special Reference to Baseline Intracranial Haemorrhage Score in Haemorrhagic Stroke in North East India - A Hospital Based Cross-Sectional Study

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/204 ◽

2021 ◽

Vol 10 (13) ◽

pp. 947-951

Author(s):

Balaji Dhanabalan ◽

Anupam Dutta ◽

Ajit Kumar Pegu ◽

Bharath H. R ◽

Bhabani Sankar Dhal

Keyword(s):

Risk Factor ◽

Basal Ganglia ◽

Intracranial Haemorrhage ◽

Haemorrhagic Stroke ◽

Stroke Patients ◽

North East India ◽

North East ◽

Ich Score ◽

Gcs Score ◽

Time Of Presentation

BACKGROUND As defined by World Health Organization (WHO), stroke is accountable for 5 million deaths and 5 million disabled patients throughout the world. The prevalence of stroke is in rising trend in Indian subcontinent and therefore is a source of socioeconomic concern. This study was conducted to evaluate the aetiological and clinical profile in stroke patients with special reference to baseline intracranial haemorrhage (ICH) score in haemorrhagic stroke in North East India. METHODS The study was carried out among in-patients of Medicine Department at Assam Medical College and Hospital, Dibrugarh in North East India from March 2019 to February 2020. A total of 112 patients who presented with symptoms suggestive of stroke were assessed. Mean ± standard deviation was used to express continuous variables. Frequency and percentage were used to express categorical variables. Test of significance for qualitative data was assessed by chi-square test (for 2 x 2 tables). P-value less than 0.05 was taken as statistically significant. RESULTS In our study stroke was common in 40 – 60 years age group which comprised 50 % of total patients. Stroke was more common in males with a sex ratio of 1.24:1. 73.2 % of patients suffered haemorrhagic stroke and 22.3 % suffered ischemic stroke whereas 4.5 % suffered cardio-embolic stroke. Hypertension was the most prevalent and an important risk factor with 80.3 % (P = 0.001), followed by smoking with 39 % (P = 0.021), chronic alcohol consumption with 37 % (P = 0.028) and diabetes with 22 %. The most common site of haemorrhage was basal ganglia (28 %) followed by thalamus (24 %). Patients presenting with intraventricular extension, infratentorial location, low Glasgow Coma Scale (GCS) score (< 4) or having high ICH score (≥ 3) at the time of presentation were associated with increased mortality in haemorrhagic stroke (P = 0.010). CONCLUSIONS Haemorrhagic strokes (73.2 %) are the most common type. Hypertension is the most prevalent and an important risk factor (80.3 %). Basal ganglia (28 %) are the most common sites involved in haemorrhagic stroke; infratentorial location is associated with poor prognosis. Patients presenting with low GCS score (< 4) or having high ICH score (≥ 3) at the time of presentation are associated with increased mortality in haemorrhagic stroke. KEY WORDS Stroke, Hypertension, Basal Ganglia, GCS Score, ICH Score

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Hypertension and Stroke: Update on Treatment

European Cardiology Review ◽

10.15420/ecr.2019.11.1 ◽

2019 ◽

Vol 14 (2) ◽

pp. 111-115 ◽

Cited By ~ 10

Author(s):

Mauricio Wajngarten ◽

Gisele Sampaio Silva

Keyword(s):

Blood Pressure ◽

Haemorrhagic Stroke ◽

Hypertensive Encephalopathy ◽

First Episode ◽

Pressure Management ◽

Stroke Patients ◽

Common Cause ◽

Therapeutic Goals ◽

Hypertensive Urgencies ◽

Definition Of

Stroke is the second most common cause of mortality worldwide and the third most common cause of disability. Hypertension is the most prevalent risk factor for stroke. Stroke causes and haemodynamic consequences are heterogeneous which makes the management of blood pressure in stroke patients complex requiring an accurate diagnosis and precise definition of therapeutic goals. In this article, the authors provide an updated review on the management of arterial hypertension to prevent the first episode and the recurrence. They also present a discussion on blood pressure management in hypertensive urgencies and emergencies, especially in the acute phase of hypertensive encephalopathy, ischaemic stroke and haemorrhagic stroke.

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Diagnostic and Treatment Features of Stroke Patients Based on RAPID Artificial Intelligent (RAPID AI) Software Analysis in Phu Tho Provincial General Hospital in Vietnam (Preprint)

10.2196/preprints.30061 ◽

2021 ◽

Author(s):

Ngoc Huy Nguyen ◽

Minh Van Hoang ◽

An Quang Nguyen ◽

Thong Van Nguyen ◽

Luc Quang Tran ◽

...

Keyword(s):

Blood Pressure ◽

General Hospital ◽

Cerebral Circulation ◽

Clinical Signs ◽

Case Series ◽

Diagnosis And Treatment ◽

Stroke Patients ◽

Permanent Disability ◽

Software Analysis ◽

Number Of Patients

BACKGROUND Stroke is the second leading cause of death and the leading cause of permanent disability global-ly. Vietnam is a developing country with a high prevalence of stroke. This study was conducted from October 2019 to October 2020 at Phu Tho Provincial General Hospital, Vietnam. OBJECTIVE The study aimed to determine and describe the characteristics of 54 acute ischemic stroke patients for whom Rapid AI technology was used for imaging analysis for diagnosis and treatment. METHODS This study was a case series based on data from the electronic medical records of stroke patients admitted to Phu Tho Provincial General Hospital between October 2019 and October 2020, for whom Rapid AI was used to analyze images of stroke. RESULTS The highlighted results showed that the mean age of patients was 73.39 ± 12.46 years and males comprised 57.4 of the sample. The most common risk factor identified was hypertension (75.9%), followed by atrial fibrillation (24.1%), diabetes (20.4%), alcohol habits (14.8%), and smoking (9.3%). The most common clinical signs were hemiparesis, observed in 75.9% of the patients, fol-lowed by dysphasia in 50.0% and memory loss in 27.8% of the sample. Small numbers of stroke patients had clinical presentations of dizziness (7.4%) and headache (7.4%). In total, 5.6% of stroke patients had a bad prognosis, presenting with unconsciousness and near death. The sub-clinical characteristics included high blood pressure in 48 (88.9%) patients, and the median score for blood pressure was 151.22 ± 22.89 mmHg. The red blood cells and triglyceride were mostly at normal concentrations. The prevalence of elevated blood glucose was 40.7%, while the preva-lence of high cholesterol was 33.3%. A small number of patients showed an abnormal platelet count (5.6%) and INR (3.7%). ASPECTS evaluation showed that 24 (44.4%) patients had good ASPECTS scores of 8–10, 17 (31.5%) patients had bad ASPECTS scores of 5–7, and 13 (24.1%) patients had the worst ASPECTS scores of 0–4. The number of patients with an infarct core vol-ume <70 mL was 50 (92.6%), while a mismatch volume of >15 mL was observed in 31 (54.7%) patients and 22 (40.7%) patients had a mismatch ratio >1.8. The assessment of CT imaging of thrombi showed 51 cases of anterior cerebral circulation, including 13 (24.07%) cases diagnosed as ICA, 30 (75.93%) cases diagnosed as MCA, and 8 (14.81%) cases diagnosed as SA. There were 10 cases of MCA-M1 (18.52%), 7 cases of MCA-M2 and MCA-M4 (12.96%) cases and 6 cases of MCA-M3 (11.11%), respectively. There were only three cases of posterior cerebral circulation, comprising one (1.85%) case of PCA and two (3.72%) cases of BA. CONCLUSIONS These are the first results regarding the clinical and subclinical features of patients with stroke investigated using Rapid AI for diagnosis and treatment in Vietnam in general, and specifically in Phu Tho Provincial General Hospital.

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High diastolic blood pressure is a risk factor for in-hospital mortality in complete MCA stroke patients

Neurological Sciences ◽

10.1007/s10072-011-0767-1 ◽

2011 ◽

Vol 33 (3) ◽

pp. 545-549 ◽

Cited By ~ 12

Author(s):

Valeria Caso ◽

Giancarlo Agnelli ◽

Andrea Alberti ◽

Michele Venti ◽

Monica Acciarresi ◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Hospital Mortality ◽

Diastolic Blood Pressure ◽

Stroke Patients

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Hubungan Tekanan Darah dengan Volume Pendarahan Intraserebral pada Pasien Stroke Hemoragik di Ruang Rawat Inap Saraf Rumkital Dr Ramelan Surabaya

Hang Tuah Medical journal ◽

10.30649/htmj.v16i2.176 ◽

2019 ◽

Vol 16 (2) ◽

pp. 135

Author(s):

KENNY YULIAN ◽

OLIVIA MAHARDANI ADAM ◽

LESTARI DEWI

Keyword(s):

Blood Pressure ◽

Ct Scan ◽

Intracerebral Haemorrhage ◽

Hemorrhagic Stroke ◽

Haemorrhagic Stroke ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

The Brain

ABSTRACTBackground. Hemorrhagic stroke is a spontaneous bleeding in the brain that is usually life threatening. The most common risk factor of hemorrhagic stroke is hypertension. Hypertension can cause change in the structure of the artery wall which can cause the blood vessels near the brain to rupture easily. Purpose. To analyze the correlation between blood pressure and intracerebral haemorrhage volume in hemorrhagic stroke patients in Dr. Ramelan Navy Hospital neurologic ward. Method. This research is using a cross sectional study design. This study is done using primary data collection, using the head CT Scan result to measure the patient’s intracerebral hemorrhage volume and patient’s ER admission data for the blood pressure. Results. The study is performed to 26 haemorrhagic stroke patients who fits the inclusion and exclusion criteria. Correlation test shows no correlation between blood pressure and intracerebral haemorrhage volume in haemorrhagic stroke patients in Dr. Ramelan Navy Hospital neurologic ward, with significance (p) value of 0.888 > α (0.05). Conclusion. There is no correlation between blood pressure and intracerebral haemorrhage volume in haemorrhagic stroke patients in Dr. Ramelan Navy Hospital neurologic ward.Keywords: Blood Pressure, Intracerebral Haemorrhage Volume, Haemorrhagic Stroke ABSTRAKLatar belakang. Stroke hemoragik adalah pendarahan otak spontan yang seringkali mengancam jiwa. Faktor resiko utama terjadinya stroke hemoragik adalah adanya hipertensi. Hipertensi dapat menyebabkan perubahan struktur dinding arteri sehingga pembuluh darah didekat otak mudah ruptur. Tujuan penelitian. Mengetahui hubungan antara tekanan darah dengan volume pendarahan intraserebral pada pasien stroke hemoragik di ruang rawat inap saraf RUMKITAL Dr. Ramelan Surabaya. Metode penelitian. Penelitian ini adalah penelitian dengan desain cross sectional study. Penelitian ini dilakukan dengan perolehan data primer, yaitu berupa hasil CT scan kepala untuk mengetahui volume pendarahan intraserebral pasien dan data pasien saat masuk IGD untuk tekanan darah pasien. Hasil. Penelitian dilakukan pada 26 pasien stroke hemoragik yang masuk kriteria inklusi dan eksklusi. Hasil uji korelasi menunjukkan tidak ada hubungan antara tekanan darah dengan volume pendarahan intraserebral pada pasien stroke hemoragik di ruang rawat inap saraf RUMKITAL Dr. Ramelan Surabaya, dengan nilai signifikansi (p) = 0.888 > α (0.05). Kesimpulan. Tidak ada hubungan antara tekanan darah dengan volume pendarahan intraserebral pada pasien stroke hemoragik di ruang rawat inap saraf RUMKITAL Dr. Ramelan Surabaya.Kata Kunci : Tekanan Darah, Volume Pendarahan Intraserebral, Stroke Hemoragik

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SMASH Score as a Predictor off-in Hospital Mortality for Acute Heart Failure Patients

Indonesian Journal of Cardiology ◽

10.30701/ijc.v38i4.786 ◽

2018 ◽

Vol 38 (4) ◽

pp. 207-217

Author(s):

Zunaidi Syahputra ◽

Hilfan Ade Putra Lubis ◽

Zainal Safri ◽

Harris Hasan

Keyword(s):

Blood Pressure ◽

Hospital Mortality ◽

Scoring System ◽

Multivariable Analysis ◽

Multivariate Logistic Regression Analysis ◽

Predict Hospital Mortality ◽

Lemeshow Test ◽

Esc Guidelines ◽

Qrs Duration ◽

New Scoring

Background: The prognosis of AHF patients remain poor. The aim of this study is to design a simple, bedside clinical prognostic scoring model and validate its ability to predict hospital mortality for patients with AHF. Methods: 255 patients with AHF were enrolled, divided into dead (n=121) and survival (n=134) cohorts. The data were collected from January 2015 to September 2016.Data were collected restropectively. Multivariable analysis was applied to determine independent risk factors and develop the scoring system. Results: The Multivariate logistic regression analysis, hospital mortality was employed as dependent variable, while age umur (p=0.014,OR 4.314 CI 95%(1.346-13.822)), Diastolic Blood Pressure (p= 0.001 OR 6.213 CI 95%(2.1210-18.205 )), Systolic Blood Pressure ( p=0.002 OR 5.043 CI 95%( 1.854-13.717)), Heart Rate ( p=0.002 OR 3.933 CI 95%(1.658-9.332)), haemoglobin ( p = 0.044 OR 2.530 CI95%(1.026-6.242)), arrhytmia ( p=0.001 OR 7.658 CI 95%(2.217-26.457)), creatinine on admission ( p=0.002 OR 4.385 CI 95% (1.731-11.104)), QRS duration (p=0.00 OR 7.684, CI 95% (3.063-19.279)), as independent variables.According to each OR of these variables, we set the new scoring system of hospital mortality for AHF with good calibration by Hosner-lemeshow test ( p =1) and discrimination by AUC 0.925 (p<0.01 CI 95 % 0.891-0.959). The optimal cutt off for prediction mortality was total 6 points, sensitivity 81% and specificity 89%. We divided the patients with AHF as low risk whom total score 0-3 points (mortality in hospital 0-2%), moderate risk whom total score 4-5 points (mortality in hospital 13-46%), and 6-12 point as high risk. In the validation cohort indicated that SMASH score as new scoring system was effective with bootstrapping. Conclusion : The SMASH Score is a new scoring system of hospital mortality for AHF can predict with good performance in terms of discrimination, calibration and internally validation. Abstrak Latar Belakang : Prognosis pasien dengan gagal jantung akut ( GJA ) masih buruk, dan stratifikasi resiko mungkin dapat membantu para klinisi dalam penatalaksanaan, dimana pasien yang tergolong buruk, harus dilakukan tindakan agressif dan pemantauan yang ketat. Namun ketersediaan sistem skoring pada GJA masih terbatas. Studi ini bertujuan untuk membuat model skoring prognostik yang sederhana dan validasinya dalam prediksi kematian di rumah sakit pada pasien GJA. Metode : 255 pasien GJA dibagi 2 kelompok yang mengalami kematian kardiovaskular dan survival di rumah sakit. Data dikumpulkan dari Januari 2015 sampai September 2016. Kriteria inklusi memenuhi panduan GJA berdasarkan ESC guidelines 2016. Dilakukan analisa multivariat dalam mencari faktor resiko yang bebas dan pembuatan sistem skoring. Hasil : Setelah dilakukan analisa multivariat logistik regressi, kematian di Rumah Sakit sebagai variable bebas, sementara umur (p=0.014,OR 4.314 KI 95%(1.346-13.822)) Tekanan darah diastolik saat masuk ( p= 0.001 OR 6.213 KI 95%(2.1210-18.205 )), tekanan darah sistolik saat masuk ( p=0.002 OR 5.043 KI 95%( 1.854-13.717)), Denyut nadi( p=0.002 OR 3.933 KI 95%(1.658-9.332)), hemoglobin ( p = 0.044 OR 2.530 KI95%(1.026-6.242)), arritmia ( p=0.001 OR 7.658 KI 95%(2.217-26.457)), kreatinin masuk ( p=0.002 OR 4.385 KI 95% (1.731-11.104)), QRS duration (p=0.00 OR 7.684, KI 95% (3.063-19.279)) sebagai variabel independen.Berdasarkan masing-masing OR dari variabel ini, diformulasikan sebuah sistem skoring . Sistem skoring yang baru memiliki kalibrasi dan diskriminasi yang sangat memuaskan menurut Hosner-lemeshow test ( p =1) dan AUC 0.925 (p<0.01 CI 95 % 0.891-0.959). Nilai titik potong yang optimal untuk prediksi kematian di rumah sakit adalah 6 poin dengan sensitivitas 81% and spesifisitas 89%. Kami menggolongkan pasien GJA sebagai resiko kematian rendah dengan total skor 0-3 poins (mortalitas di Rumah sakit 0-2%), resiko sedang dengan total skor 3-5 points (mortalitas di Rumah Sakit 13-46%), and 6-14 poin sebagai resiko tinggi. Pada validasi internal bahwa SMASH score sebagai sistem skoring kematian yang baru menunjukan nilai optimisme yang baik secara bootsrapping. Kesimpulan : SMASH Score adalah sebuah Sistem Skorring baru dalam Prediksi Kematian di Rumah Sakit pada Sindroma Gagal Jantung Akut dengan kalibrasi dan diskriminasi serta validasi yang baik.

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