Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 4, August 2019, pages 216-222

A Simplified Risk Scoring System to Predict Mortality in Cardiovascular Intensive Care Unit

**Table 1.** Baseline Characteristics of the Research Subject
Parameter	N = 595
^aMalignant arrhythmias e.g. unstable ventricular tachycardia or supraventricular tachycardia, degenerative process e.g. sinus node dysfunction or AV node dysfunction; ^bAcute decompensated heart failure whose etiology is valvular heart disease or ischemia heart disease or hypertensive heart disease; ^cAcute limb ischemia or critical limb ischemia; ^dPulmonary embolism, myocarditis and post cardiac arrest syndrome. STEAMI: ST-elevation acute myocardial infarction; NSTEAMI: non-ST-elevation acute myocardial infarction; CHF: chronic heart failure; SGOT: serum glutamic oxaloacetic transaminase; SGPT: serum glutamic pyruvate transaminase; TAPSE: tricuspid annular plane systolic excursion.
Age, year ± SD	59.92 ± 13.0
Gender
Male, n (%)	428 (71.9)
Female, n (%)	167 (28.1)
Diagnosis
Arrhythmia^a, n (%)	84 (14.1)
Acute coronary syndrome, n (%)	416 (69.9)
STEAMI	290 (69.7)
NSTEAMI	126 (30.3)
Worsening of CHF^b, n (%)	25 (4.2)
Peripheral vascular disease^c, n (%)	22 (3.7)
Post open heart surgery, n (%)	27 (4.5)
Others^d, n (%)	21 (3.5)
Comorbid factor
Pneumonia, n (%)	47 (7.9)
Hypertension, n (%)	324 (54.5)
Diabetes mellitus, n (%)	162 (27.2)
Mortality, n (%)	55 (9.2)
Ventilator utilization, n (%)	33 (5.5)
Laboratory examination
Hemoglobin, g/dL ± SD	13.7 ± 7.9
Thrombocyte, cell/mm³ ± SD	251.7 ± 82.3
Neutrophil, cell/mm³ ± SD	76.1 ± 30.0
Lymphocyte, cell/mm³ ± SD	16.8 ± 12.2
Creatinine, mg/dL ± SD	2.38 ± 13.8
Blood sugar, mg/dL ± SD	164.8 ± 94.0
SGOT, U/L ± SD	101.9 ± 313.2
SGPT, U/L ± SD	55.2 ± 156.6
Echocardiography examination
Ejection fraction, % ± SD	51.1 ± 13.3
TAPSE, mm ± SD	18.2 ± 5.2

Table 1. Baseline Characteristics of the Research Subject

Parameter

N = 595

^aMalignant arrhythmias e.g. unstable ventricular tachycardia or supraventricular tachycardia, degenerative process e.g. sinus node dysfunction or AV node dysfunction; ^bAcute decompensated heart failure whose etiology is valvular heart disease or ischemia heart disease or hypertensive heart disease; ^cAcute limb ischemia or critical limb ischemia; ^dPulmonary embolism, myocarditis and post cardiac arrest syndrome. STEAMI: ST-elevation acute myocardial infarction; NSTEAMI: non-ST-elevation acute myocardial infarction; CHF: chronic heart failure; SGOT: serum glutamic oxaloacetic transaminase; SGPT: serum glutamic pyruvate transaminase; TAPSE: tricuspid annular plane systolic excursion.

Age, year ± SD

59.92 ± 13.0

Gender

Male, n (%)

428 (71.9)

Female, n (%)

167 (28.1)

Diagnosis

Arrhythmia^a, n (%)

84 (14.1)

Acute coronary syndrome, n (%)

416 (69.9)

STEAMI

290 (69.7)

NSTEAMI

126 (30.3)

Worsening of CHF^b, n (%)

25 (4.2)

Peripheral vascular disease^c, n (%)

22 (3.7)

Post open heart surgery, n (%)

27 (4.5)

Others^d, n (%)

21 (3.5)

Comorbid factor

Pneumonia, n (%)

47 (7.9)

Hypertension, n (%)

324 (54.5)

Diabetes mellitus, n (%)

162 (27.2)

Mortality, n (%)

55 (9.2)

Ventilator utilization, n (%)

33 (5.5)

Laboratory examination

Hemoglobin, g/dL ± SD

13.7 ± 7.9

Thrombocyte, cell/mm³ ± SD

251.7 ± 82.3

Neutrophil, cell/mm³ ± SD

76.1 ± 30.0

Lymphocyte, cell/mm³ ± SD

16.8 ± 12.2

Creatinine, mg/dL ± SD

2.38 ± 13.8

Blood sugar, mg/dL ± SD

164.8 ± 94.0

SGOT, U/L ± SD

101.9 ± 313.2

SGPT, U/L ± SD

55.2 ± 156.6

Echocardiography examination

Ejection fraction, % ± SD

51.1 ± 13.3

TAPSE, mm ± SD

18.2 ± 5.2

**Table 2.** Baseline Characteristic of the Research Subject (Survivor versus Non-Survivor)
Parameter	Survivor (N = 540)	Non-survivor (N = 55)	P value
*Statistically significant (P < 0.05).
Age, year ± SD	59.8 ± 12.9	61.3 ± 13.5
Age ≥ 60 years, n (%)	284 (52.6)	33 (60)	0.226
Gender			0.789
Male, n (%)	428 (71.9)	38 (69.1)
Female, n (%)	167 (28.1)	17 (30.9)
Diagnosis
Arrhythmia, n (%)	82 (15.2)	2 (3.6)
Acute coronary syndrome, n (%)	380 (70.4)	36 (65.5)	0.585
STEAMI	265 (69.7)	25 (69.4)
NSTEAMI	115 (30.3)	11 (30.6)
Worsening of CHF, n (%)	21 (3.9)	4 (7.3)
Peripheral vascular disease, n (%)	19 (3.5)	3 (5.5)
Post open heart surgery, n (%)	27 (5.0)	-
Others, n (%)	11 (2.0)	10 (18.2)
Comorbid factor
Pneumonia, n (%)	29 (5.4)	18 (32.7)	≤ 0.0001*
Hypertension, n (%)	298 (55.2)	26 (47.3)	0.329
Diabetes mellitus, n (%)	140 (25.9)	22 (40)	0.019*
Ventilator utilization, n (%)	11 (2.0)	22 (40)	≤ 0.0001*
Laboratory examination
Hemoglobin < 10 g/dL, n (%)	41 (7.6)	9 (16.4)	0.022*
Creatinine > 1.5 mg/dL, n (%)	153 (28.3)	33 (60)	0.000*
Blood sugar > 200 mg/dL, n (%)	107 (19.8)	20 (36.4)	0.003*
SGOT > 50 U/L, n (%)	190 (35.2)	33 (60)	0.001*
SGPT > 50 U/L, n (%)	113 (20.9)	25 (45.5)	≤ 0.0001*
Echocardiography examination
Ejection fraction < 40% ± SD	87 (16.1)	24 (43.6)	≤ 0.0001*
TAPSE < 17 mm ± SD	154 (28.5)	30 (54.5)	≤ 0.0001*

Table 2. Baseline Characteristic of the Research Subject (Survivor versus Non-Survivor)

Parameter

Survivor (N = 540)

Non-survivor (N = 55)

P value

*Statistically significant (P < 0.05).

Age, year ± SD

59.8 ± 12.9

61.3 ± 13.5

Age ≥ 60 years, n (%)

284 (52.6)

33 (60)

0.226

Gender

0.789

Male, n (%)

428 (71.9)

38 (69.1)

Female, n (%)

167 (28.1)

17 (30.9)

Diagnosis

Arrhythmia, n (%)

82 (15.2)

2 (3.6)

Acute coronary syndrome, n (%)

380 (70.4)

36 (65.5)

0.585

STEAMI

265 (69.7)

25 (69.4)

NSTEAMI

115 (30.3)

11 (30.6)

Worsening of CHF, n (%)

21 (3.9)

4 (7.3)

Peripheral vascular disease, n (%)

19 (3.5)

3 (5.5)

Post open heart surgery, n (%)

27 (5.0)

Others, n (%)

11 (2.0)

10 (18.2)

Comorbid factor

Pneumonia, n (%)

29 (5.4)

18 (32.7)

≤ 0.0001*

Hypertension, n (%)

298 (55.2)

26 (47.3)

0.329

Diabetes mellitus, n (%)

140 (25.9)

22 (40)

0.019*

Ventilator utilization, n (%)

11 (2.0)

22 (40)

≤ 0.0001*

Laboratory examination

Hemoglobin < 10 g/dL, n (%)

41 (7.6)

9 (16.4)

0.022*

Creatinine > 1.5 mg/dL, n (%)

153 (28.3)

33 (60)

0.000*

Blood sugar > 200 mg/dL, n (%)

107 (19.8)

20 (36.4)

0.003*

SGOT > 50 U/L, n (%)

190 (35.2)

33 (60)

0.001*

SGPT > 50 U/L, n (%)

113 (20.9)

25 (45.5)

≤ 0.0001*

Echocardiography examination

Ejection fraction < 40% ± SD

87 (16.1)

24 (43.6)

≤ 0.0001*

TAPSE < 17 mm ± SD

154 (28.5)

30 (54.5)

≤ 0.0001*

**Table 3.** Multivariate Analysis of Factors Predicting Mortality (N = 595 Patients)
Parameter	OR	95% CI	P value
*Statistically significant (P < 0.1) after backward stepwise method analysis. OR: odds ratio.
Age ≥ 60 years	1.97	0.926 - 4.192	0.078*
Comorbid pneumonia	2.51	0.992 - 6.37	0.052*
Diabetes mellitus	1.08	0.432 - 2.734	0.86
Ventilator utilization	20.98	7.672 - 57.406	< 0.0001*
Hemoglobin < 10 g/dL	1.35	0.456 - 3.997	0.587
TAPSE < 17 mm	1.70	0.837 - 3.468	0.142
SGOT > 50 U/L	1.42	0.604 - 3.339	0.421
SGPT > 50 U/L	1.70	0.704 - 4.107	0.028*
Random blood sugar > 200 mg/dL	1.19	0.465 - 3.037	0.717
Creatinine > 1.5 mg/dL	2.97	1.475 - 5.971	0.002*
Ejection fraction < 40%	2.21	1.077 - 4.554	0.031*

Table 3. Multivariate Analysis of Factors Predicting Mortality (N = 595 Patients)

Parameter

95% CI

P value

*Statistically significant (P < 0.1) after backward stepwise method analysis. OR: odds ratio.

Age ≥ 60 years

1.97

0.926 - 4.192

0.078*

Comorbid pneumonia

2.51

0.992 - 6.37

0.052*

Diabetes mellitus

1.08

0.432 - 2.734

0.86

Ventilator utilization

20.98

7.672 - 57.406

< 0.0001*

Hemoglobin < 10 g/dL

1.35

0.456 - 3.997

0.587

TAPSE < 17 mm

1.70

0.837 - 3.468

0.142

SGOT > 50 U/L

1.42

0.604 - 3.339

0.421

SGPT > 50 U/L

1.70

0.704 - 4.107

0.028*

Random blood sugar > 200 mg/dL

1.19

0.465 - 3.037

0.717

Creatinine > 1.5 mg/dL

2.97

1.475 - 5.971

0.002*

Ejection fraction < 40%

2.21

1.077 - 4.554

0.031*

**Table 4.** Assessment of the Score Value From Each Independent Predictor Factor
Parameter	B	SE	B/SE	(B/SE)/x	Score
Age ≥ 60 years	0.678	0.385	1.76	1	1
Pneumonia	0.922	0.478	1.92	1.09	1
Ventilator	3.061	0.509	6.01	3.41	3
SGPT > 50 U/L	0.782	0.356	2.19	1.24	1
Creatinine > 1.5 mg/dL	1.088	0.357	3.04	1.73	2
Ejection fraction < 40%	0.795	0.368	2.16	1.22	1

Table 4. Assessment of the Score Value From Each Independent Predictor Factor

Parameter

B/SE

(B/SE)/x

Score

Age ≥ 60 years

0.678

0.385

1.76

Pneumonia

0.922

0.478

1.92

1.09

Ventilator

3.061

0.509

6.01

3.41

SGPT > 50 U/L

0.782

0.356

2.19

1.24

Creatinine > 1.5 mg/dL

1.088

0.357

3.04

1.73

Ejection fraction < 40%

0.795

0.368

2.16

1.22

**Table 5.** Scoring System Based on Patient’s Probability on Mortality Event
Score	Probability (%)
0	1.1
1	2.4
2	5.3
3	11.1
4	21.8
5	38.5
6	58.4
7	75.9
8	87.6
9	94.1

Table 5. Scoring System Based on Patient’s Probability on Mortality Event

Score

Probability (%)

1.1

2.4

5.3

11.1

21.8

38.5

58.4

75.9

87.6

94.1

**Table 6.** Sensitivity and Specificity of Each Graphic Point Towards Patient’s Probability to Experience Mortality Event
No	Positive if greater than or equal to	Sensitivity	1 - Specificity	Sensitivity	Specificity
1	-1.0000	1.000	1.000	1.000	0.000
2	0.5000	1.000	0.749	1.000	0.251
3	1.5000	0.907	0.416	0.907	0.584
4	2.5000	0.796	0.264	0.796	0.736
5	3.5000	0.630	0.098	0.630	0.902
6	4.5000	0.370	0.030	0.370	0.970
7	5.5000	0.278	0.009	0.278	0.991
8	6.5000	0.204	0.007	0.204	0.993
9	7.5000	0.074	0.004	0.074	0.996
10	8.5000	0.019	0.000	0.019	1.000
11	10.0000	0.000	0.000	0.000	1.000

Table 6. Sensitivity and Specificity of Each Graphic Point Towards Patient’s Probability to Experience Mortality Event

Positive if greater than or equal to

Sensitivity

1 - Specificity

Sensitivity

Specificity

-1.0000

1.000

0.000

0.5000

1.000

0.749

1.000

0.251

1.5000

0.907

0.416

0.907

0.584

2.5000

0.796

0.264

0.796

0.736

3.5000

0.630

0.098

0.630

0.902

4.5000

0.370

0.030

0.370

0.970

5.5000

0.278

0.009

0.278

0.991

6.5000

0.204

0.007

0.204

0.993

7.5000

0.074

0.004

0.074

0.996

8.5000

0.019

0.000

0.019

1.000

10.0000

0.000

1.000