Abstract 2559: A Validated Clinical and Biochemical Risk Score for Prediction of One-Year Mortality in Dyspneic Emergency Department Patients: The ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Mortality Risk Score
Background: No method of risk stratification for patients with acute dyspnea, unifying both clinical and biochemical predictors of risk, has been reported.
Methods: 599 dyspneic subjects were evaluated to examine the diagnostic utility of NT-proBNP (Elecsys® proBNP, Roche Diagnostics, Indianapolis, IN) measurement. Assessment of 1-year vital status was performed. Factors independently predictive of death by 1-year were used to develop a mortality risk prediction tool. Score validation in a similar population of patients from Christchurch, New Zealand was performed.
Results: Seven factors comprise the scoring tool (adjustments for β coefficient noted): age (multiplied by 0.7), heart rate (multiplied by 0.5), blood urea nitrogen (multiplied by 0.5), NHYA Class (class multiplied by 5), NT-proBNP ≥ 986 pg/ml (18 points), systolic blood pressure < 100 mmHg (11 points), and presence of a murmur (11 points). We observed a continuous rise in the rates of 1-year mortality across score quintiles ranging from 1.7% (quintile 1, n=116, score ≤48.5) to 43.1% (quintile 5, n=116, score ≤ 85.5). ROC curve analysis of the score produced an area under the curve (AUC) of 0.82 (95% CI= 0.78 – 0.85; p<0.0001). The scoring tool performed well both in subjects with ADHF (AUC=0.73, 95% CI=0.67– 0.79; p<0.0001) and in those with alternative causes of dyspnea (AUC=0.83, 95% CI=0.77– 0.85; p<0.0001). Lastly, the utility of the score to predict death at 1 year was validated in an external data set (p<0.001).
Conclusion: We have derived and validated a novel risk score for prediction of mortality in patients with acute dyspnea that combines factors from standard clinical evaluation plus NT-proBNP testing.