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Incremental value of C‐reactive protein to the MEESSI acute heart failure risk score

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Title: Incremental value of C‐reactive protein to the MEESSI acute heart failure risk score
Authors: Wussler, Desiree, Belkin, Maria, Shrestha, Samyut, Wernicke, Hannah, Papachristou, Androniki, Nowak, Albina, Aliyeva, Fatima, Mork, Constantin, Strebel, Ivo, Huré, Gabrielle Valerie Francoi, Weil, Dominic, Michou, Eleni, Kozhuharov, Nikola, Gualandro, Danielle Menosi, Puelacher, Christian, Miró, Òscar, Rossello, Xavier, Martín-Sánchez, Francisco Javier, Pocock, Stuart J, Goudev, Assen, Breidthardt, Tobias, Mueller, Christian
Contributors: University of Zurich, Wussler, Desiree, Mueller, Christian
Source: Docusalut
Conselleria de Salut i Consum del Govern de les Illes Balears
Publisher Information: Wiley, 2024.
Publication Year: 2024
Subject Terms: Male, Anciano, 10265 Clinic for Endocrinology and Diabetology, 610 Medicine & health, Enfermedad Aguda, Estudios Retrospectivos, Risk Assessment, 2705 Cardiology and Cardiovascular Medicine, Risk Factors, Servicio de Urgencia en Hospital, Biomarkers / blood, Humans, Heart Failure* / mortality, Prospective Studies, Masculino, Heart Failure* / blood, Aged, Retrospective Studies, Factores de Riesgo, Heart Failure, Aged, 80 and over, Persona de Mediana Edad, Femenino, Pronóstico, C-Reactive Protein* / metabolism, Estudios Prospectivos, Middle Aged, Prognosis, Humanos, 3. Good health, C-Reactive Protein, Risk Assessment / methods, Acute Disease, Female, Emergency Service, Hospital, Biomarkers
Description: AimsWe hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI‐AHF) risk score, can be further improved by adding systemic inflammation as quantified by C‐reactive protein (CRP).Methods and resultsIn a prospective multicentre diagnostic study (BASEL V), AHF was centrally adjudicated by two independent cardiologists. The MEESSI‐AHF risk score was calculated using an established reduced and recalibrated model containing 12 independent risk factors. Model extension was performed by refitting and adding CRP in the logistic regression model with 30‐day mortality as binary outcome. Discrimination, calibration and clinical usefulness were used to assess the performance of the extended Multiple Estimation of risk based on the Emergency department Spanish Score In patients (MEESSI) model. Validation was performed in an independent, retrospective and single‐centre AHF cohort. Among 1208 AHF patients with complete data allowing calculation of the recalibrated MEESSI and the extended MEESSI models, the prognostic accuracy for 30‐day mortality of the extended MEESSI model (c‐statistic 0.83, 95% confidence interval [CI] 0.79–0.87) was significantly higher compared to the recalibrated model (c‐statistic 0.79, 95% CI 0.75–0.83, p = 0.013). The extended model allowed to stratify a higher percentage of patients into the lowest risk group compared to the recalibrated model (33.1% vs. 20.3%). Demonstrating a calibration plot's slope of 1.00 (95% CI 0.81–1.19) and an intercept of 0.0 (95% CI −0.22 to 0.22), the extended MEESSI model achieved excellent and improved calibration. Results were confirmed in the independent validation cohort (n = 575).ConclusionsQuantifying inflammation using CRP concentration provided incremental value in AHF risk stratification using the established MEESSI model.
Document Type: Article
Other literature type
File Description: application/pdf; ZORA_274870.pdf - application/pdf
Language: English
ISSN: 1879-0844
1388-9842
DOI: 10.1002/ejhf.3349
DOI: 10.5167/uzh-274870
Access URL: https://pubmed.ncbi.nlm.nih.gov/38923253
https://hdl.handle.net/20.500.13003/20651
Rights: CC BY NC
Accession Number: edsair.doi.dedup.....f7a9dcba41af8c9d76220cdc5364ed98
Database: OpenAIRE
Description
Abstract:AimsWe hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI‐AHF) risk score, can be further improved by adding systemic inflammation as quantified by C‐reactive protein (CRP).Methods and resultsIn a prospective multicentre diagnostic study (BASEL V), AHF was centrally adjudicated by two independent cardiologists. The MEESSI‐AHF risk score was calculated using an established reduced and recalibrated model containing 12 independent risk factors. Model extension was performed by refitting and adding CRP in the logistic regression model with 30‐day mortality as binary outcome. Discrimination, calibration and clinical usefulness were used to assess the performance of the extended Multiple Estimation of risk based on the Emergency department Spanish Score In patients (MEESSI) model. Validation was performed in an independent, retrospective and single‐centre AHF cohort. Among 1208 AHF patients with complete data allowing calculation of the recalibrated MEESSI and the extended MEESSI models, the prognostic accuracy for 30‐day mortality of the extended MEESSI model (c‐statistic 0.83, 95% confidence interval [CI] 0.79–0.87) was significantly higher compared to the recalibrated model (c‐statistic 0.79, 95% CI 0.75–0.83, p = 0.013). The extended model allowed to stratify a higher percentage of patients into the lowest risk group compared to the recalibrated model (33.1% vs. 20.3%). Demonstrating a calibration plot's slope of 1.00 (95% CI 0.81–1.19) and an intercept of 0.0 (95% CI −0.22 to 0.22), the extended MEESSI model achieved excellent and improved calibration. Results were confirmed in the independent validation cohort (n = 575).ConclusionsQuantifying inflammation using CRP concentration provided incremental value in AHF risk stratification using the established MEESSI model.
ISSN:18790844
13889842
DOI:10.1002/ejhf.3349