The Updated Harborview Score Successfully Predicts Mortality After Ruptured Aortic Aneurysm

The Harborview Medical Center (HMC) score predicts mortality in patients presenting with ruptured abdominal aortic aneurysms (rAAA) using four criteria: systolic blood pressure (<70 mm Hg), creatinine (>2.0 mg/dL), age (>76 years), and preoperative arterial pH (<7.2). Challenges obtaining arterial pH values limit the clinical utility of this scoring system. International normalized ratio (INR >1.8) has been proposed as an acceptable substitution when arterial blood gases are not available preoperatively. Preliminary studies have shown that this modified criterion has not compromised the accuracy of the original HMC scoring system. The objective of this study is to validate the updated HMC-INR/pH scoring system. We conducted a retrospective analysis of patients presenting with rAAA at a single tertiary care center from 2011 to 2022. The Vascular Study Group of New England (VSGNE) score was used for comparison. The primary outcome was 30-day in-hospital mortality. Logistic regression and receiver operating characteristic curves were used to assess scoring system performance. Categorical and continuous data were compared using c2 and Student's t tests, respectively. Of 91 patients identified during the study period, 69 patients met inclusion criteria. Fifty patients underwent endovascular repair (rEVAR) and 19 patients received open repairs (rOR). All 69 patients had available INR values, and 62 patients (89.8%) had available arterial pH values. In-hospital mortality was 38% overall (30% for rEVAR vs 58% for rOR). There was a stronger linear relationship between the HMC-INR/pH score and in-hospital mortality rate (Figure; R2 = 0.97) than the VSGNE score (R2 = 0.94). There was no significant difference in the area under the receiver operating characteristic curves between the HMC-INR/pH and VSGNE scores (0.70 [95% confidence interval (CI), 0.56-0.83; P = .007] vs 0.69 [95% CI, 0.56-0.82]; P = .01, respectively). Logistic regression analysis showed a significant correlation between creatinine (odds ratio 4.0; 95% CI, 1.2-13.8; P = .03), systolic blood pressure (3.8; 95% CI, 1.3-11.1; P = .02), age (1.7; 95% CI, 1.1-7.4; P = .04) and in-hospital mortality. The HMC-INR/pH score accurately predicted 30-day in-hospital mortality after rAAA repair using either arterial pH <7.2 or INR >1.8. By using easily obtainable preoperative variables, the HMC-INR/pH score has broader clinical utility making it a superior scoring system to the original HMC and VSGNE scores.