Derivation and validation of a simple prognostic risk score to predict shortterm mortality in acute cardiogenic pulmonary edema: the SABIHA score

Abstract

Objective Acute cardiogenic pulmonary edema (ACPE) is a frequently encountered medical emergency associated with high early mortality rates, but existing tools to predict short-term outcomes for risk stratification have several limitations. Our aim was to derive and validate a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests for accurate prediction of short-term mortality in individuals experiencing ACPE. Methods This retrospective cohort study comprised 1,088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio for comprehensive examination and validation of the prognostic model. Independent predictors of 30-day mortality (P<0.05) from the multivariable model were included in the risk score. Discriminant ability of the model was tested by receiver operating characteristic analysis. Results In the derivation cohort (623 patients), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring each of these factors as 0 or 1. The SABIHA (systolic blood pressure, age, blood urea nitrogen, invasive mechanical ventilation requirement, heart rate, and anemia) score provided good calibration and a concordance index of 0.879 (95% confidence interval, 0.821-0.937). While the probability of short-term mortality was 80.0% in the high-risk group, this rate was only 3.3% in the low-risk group. The SABIHA score also performed well on the validation set. Conclusion A simple clinical score consisting of routinely obtained variables can be used to predict short-term outcomes in patients with ACPE.