Prognostic scores in predicting 90-day mortality in the cardiac intensive care units

Abstract Introduction During the last years the Coronary Care Units (CCU) have evolved into Cardiac Intensive Care Units (CICU) for patients with acute cardiovascular diseases. The prognostic scores were developed in general Intensive Care Units with the aim of evaluating the severity of the disease and predicting the short-term outcome of the critically ill patients. Although a number of prognostic scores have also been used in the CICU, none of them has been proposed, so far, for prediction of the 90-day mortality which is considered a more reliable outcome metric. Purpose To evaluate the predictive ability for 90-day mortality of five prognostic scores in patients admitted to the CICU due to various cardiovascular etiologies. Methods This is a single-center, prospective cohort study in a CICU admitting patients with acute cardiovascular diseases. APACHE II, SOFA, FRAILTY and MCARS scoring systems as well as CHARLSON comorbidity index (CCI) were calculated on CICU admission. Results A total of 527 patients [mean (SD) age 70 (15) years, 69% males] were included (NSTEMI 23%, STEMI 22%, Heart Failure 10%). Crude 90-day mortality was 16%. The univariate analyses showed that all five scores (FRAILTY, MCARS, SOFA, APACHE II, and CCI) were significantly higher in non-survivors as compared to survivors. The area under the receiver operating characteristic curve (AUC) for FRAILTY, MCARS, SOFA, APACHE II, and CHARLSON’s scores was 0.83, 0.91, 0.92, 0.90, and 0.74, respectively. A multivariate logistic regression including all five prognostic scores revealed FRAILTY, MCARS and SOFA scores as independent predictors of 90-day mortality (OR, CI: 0.57, 0.42-0.77; 0.70, 0.53-0.90; 0.83, 0.70-0.99, respectively). Conclusion MCARS, SOFA, and FRAILTY scores at CICU admission were independent risk factors for 90-day mortality. Therefore, they could be recommended as tools for accurate risk stratification in patients admitted to the CICU.