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

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.

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

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

scholarly journals Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score

Critical Care ◽  
2011 ◽  
Vol 15 (4) ◽  
pp. R191 ◽  
Author(s):  
Yutaka Kondo ◽  
Toshikazu Abe ◽  
Kiyotaka Kohshi ◽  
Yasuharu Tokuda ◽  
E Francis Cook ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Scoring System ◽  
Coma Scale ◽  
Trauma Scoring

scholarly journals A New Scoring System to Predict Poor Clinical Outcomes in Acute Nonvariceal Upper Gastrointestinal Bleeding Patients with High-Risk Stigmata

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Zhiyu Dong ◽  
Junwen Wang ◽  
Tingting Zhan ◽  
Haiqin Zhang ◽  
Lisha Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Scoring Systems ◽  
Endoscopic Hemostasis ◽  
Upper Gastrointestinal ◽  
New Scoring

Aims. To explore the risk factors for rebleeding in acute nonvariceal upper gastrointestinal bleeding patients with high-risk stigmata after endoscopic hemostasis and to develop a new scoring system for them. Methods. A retrospective single-center study was conducted from January 2012 to June 2017. The logistic regression model was used to explore risk factors of poor clinical outcomes. Accuracy of new scoring systems was compared with Rockall score (RS) and Glasgow-Blatchford score (GBS) using receiver operating characteristics curve. Results. Two hundred nine patients were included. In multivariate regression analysis, systolic blood pressure, endoscopic hemostasis method, hemoglobin, blood urea nitrogen, and serum creatinine were identified as indicators for rebleeding. New scoring systems with 4 variables and 5 variables based on these 5 risk factors were chosen. The 4-variable scoring system outperformed GBS in predicting rebleeding while 5-variable scoring system outperformed RS and GBS in predicting rebleeding significantly. Score 2 was identified as the best cut-off of these 2 scoring systems. Conclusions. Systolic blood pressure, endoscopic hemostasis method, hemoglobin, blood urea nitrogen, and serum creatinine were all associated with poor clinical outcomes. The new scoring systems had greater accuracy than RS and GBS in predicting rebleeding. Further external validation should be performed to verify the results.

scholarly journals Predictors of In-Hospital Mortality in Stroke Patients

2022 ◽  
Author(s):  
Vindya Shalini Ranasinghe ◽  
Manoji Pathirage ◽  
Indika Bandara Gawarammana
Keyword(s):  
Blood Pressure ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Clinical Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Haemorrhagic Stroke ◽  
Receiver Operating Curve ◽  
Stroke Patients ◽  
Tertiary Referral Center ◽  
Gcs Score

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.

Organ System Failure Scoring System Can Predict Hospital Mortality in Critically Ill Cirrhotic Patients

2003 ◽  
Vol 37 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Ming-Hung Tsai ◽  
Yung-Chang Chen ◽  
Yu-Pin Ho ◽  
Ji-Tseng Fang ◽  
Jau-Min Lien ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Scoring System ◽  
Organ System ◽  
System Failure ◽  
Organ System Failure ◽  
Predict Hospital Mortality ◽  
Cirrhotic Patients

Analisis Faktor Determinan yang berhubungan dengan Kepatuhan Rekomendasi Modifikasi Gaya Hidup Pasien Hipertensi

2020 ◽  
Vol 7 (2) ◽  
pp. 256-263
Author(s):  
Abdul Qodir
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
Lifestyle Modifications ◽  
Chi Square ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Consecutive Sampling ◽  
Knowledge Practice

Penatalaksanaan farmakologis dan non farmakologis dipercaya dapat mengontrol tekanan darah dan mencegah komplikasi, tetapi banyak pasien hipertensi tekanan darahnya tidak terkontrol. Hal tersebut dikarenakan kepatuhan yang buruk dalam melaksanakan rekomendasi gaya hidup. Penelitian ini bertujuan untuk menganalisis determinan faktor yang berhungan dengan kepatuhan melaksanakan rekomendasi modifikasi gaya hidup. Penelitian ini menggunakan metode cross-sectional di pukesmas dinoyo Kota Malang tahun 2019. Teknik pengambilan sampel menggunakan Consecutive Sampling. Kuesioner yang digunakan meliputi : karakteristik demografi, pengetahuan dan rekomendasi mofifikasi gaya hidup pasien hipertensi. Hubungan antara rekomendasi modifikasi gaya hidup dengan variabel independen dianalisis menggunakan uji chi square dan analisis regresi logistik. 140 pasien hipertensi berpartisipasi dalam penelitian ini (60 laki-laki, 80 wanita). Prevalensi kepatuhan adalah 28,6 %. Tingkat pengetahuan berhubungan signifikan  dengan kepatuhan melaksanakan rekomendasi gaya hidup (p=0,00). Jenis kelamin, usia, dan tingkat pendidikan tidak mempunyai hubungan signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup (p= 0,06; p=0,21; p=0,87). Pengetahuan mempunyai hubungan yang signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup. Management of pharmacological and non-pharmacological is believed to control blood pressure and prevent complications,  but many hypertensive patients have uncontrolled blood pressure. This is due to poor adherence to recommended lifestyle modifications. This study was aimed to determine the factors associated with adherence to recommended lifestyle modifications of hypertensive patients. A cross-sectional study was conducted in Pukesmas Dinoyo Malang in 2019. Consecutive Sampling was used to select study subjects. The questionnaire included information about demographic characteristics, knowledge, practice of lifestyle-modification measures. Associations between adherence to lifestyle modification and independent variables were analyzed using chi square and multivariate logistic regression analysis. 140 hypertensive patients participated in the study (60 men, 80 women). The prevalence of adherence was 28.6%. The level of knowledge was significant associated with adherence to recommended lifestyle modifications (p = 0.00). Genders , age, and educational level were no significant associated with to recommended lifestyle modifications (p= 0.06; p=0.21; p=0.87). Knowledge was significant associated with adherence to recommended lifestyle modifications of hypertensive patients.

Sign in / Sign up

Export Citation Format

Share Document