Customization and external validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) in Brazilian critically ill patients.

PURPOSE: To customize and externally validate the recently proposed Simplified Mortality Score for the ICU (SMS-ICU, a simple score for 90-day mortality that has no need for ancillary testing results) for in-hospital mortality and to compare its performance to SAPS 3. MATERIAL AND METHODS: We used data from two distinct large cohorts of adult Brazilian patients with unplanned ICU admissions to perform a first-level customization (43,017 patients admitted to 78 ICUs) of the original SMS-ICU score for in-hospital mortality and, sequentially, externally validate it (313,365 patients admitted to 99 ICUs). Performance of SMS-ICU was assessed through measurements of discrimination and calibration and compared with SAPS 3. RESULTS: In the validation cohort, median SMS-ICU was 13 (IQR 8-16) points and median SAPS 3 was 44 (IQR 36-51). Discrimination of SMS-ICU was good (AUC 0.817; 95% CI 0.814-0.819) but slightly lower than of SAPS 3 (AUC 0.845; 95% CI 0.843-0.848;). The customized SMS-ICU predictions were comparable to SAPS 3 in terms of calibration. CONCLUSION: In this external validation of the SMS-ICU in a large Brazilian cohort, we observed good discrimination of SMS-ICU and acceptable calibration after first-level customization. SMS-ICU can be used as a measure of illness severity for acutely admitted ICU patients in clinical studies.

Prognostic value of B-type natriuretic peptide in the mortality of patients with acute coronary syndrome.

BACKGROUND: The prognostic value of BNP in acute coronary syndrome (ACS) has been repeatedly assessed, but not completely well established. Literature data for establishing the best time for assessing BNP, be it on hospital admission or after coronary intervention, are controversial. OBJECTIVE: To analyze BNP in non-ST segment elevation ACS (NSTE-ACS) in the long term, and to assess the association between BNP (pg/ml), death, coronary anatomy, and TIMI Risk Score. METHODS: Forty patients with NSTE-ACS and troponin>0.50 ng/ml had their BNP levels measured on admission and 96 hours after, and were followed up for four years. The difference between the two measures was assessed by use of Wilcoxon test (p<0.05). The ROC curve was used to evaluate 96-hour BNP accuracy as a death predictor, and logistic regression was used to assess a possible confounding factor among 96-hour BNP, age, and outcome. RESULTS: There was an increase in the 96-hour BNP (148 on admission vs. 267 after 96 hours; p=0.04). Thirteen patients died. For the 300 pg/ml cutoff, 96-hour BNP was a death predictor (sensitivity, 92.30%; specificity, 77.80%; positive predictive value, 66.70%; negative predictive value, 95.50%). The area under the ROC curve was 0.92. A 7.4-time increase in the relative risk of death in four years was observed with a 96-hour BNP> 300 pg/ml (95% CI 1.90 a 29.30 p<0.01). An association between 96-hour BNP and TIMI Risk Score was observed (p<0.01). An association was observed between the increase in 96-hour BNP and multivessel disease (p=0.02). CONCLUSION: In NSTE-ACS with positive troponin, 96-hour BNP can be a tool for risk stratification.

Valor prognóstico do peptídeo natriurético tipo B na mortalidade de pacientes com Síndrome Coronariana Aguda / Prognostic value of B-type natriuretic peptide in the mortality of patients with Acute Coronary Syndrome

FUNDAMENTO: O valor prognóstico do PNB na Síndrome Coronariana Aguda (SCA) tem sido repetidamente avaliado, mas ainda não completamente bem estabelecido. Os dados da literatura para estabelecer o melhor momento para avaliar o PNB, seja na admissão hospitalar, seja após a intervenção coronariana, são controversos. OBJETIVO: Analisar o PNB em SCA sem supradesnivelamento do segmento ST (Scasest), no longo prazo, e avaliar a associação entre PNB (pg/mL), morte, anatomia coronariana, e Escore de Risco TIMI. MÉTODOS: Quarenta pacientes com Scasest e troponina > 0,50 ng/mL tiveram seus níveis de PNB medidos na admissão e 96 horas depois, e foram acompanhados por quatro anos. A diferença entre as duas medidas foi avaliada utilizando o teste de Wilcoxon (p < 0,05). A curva ROC foi utilizada para avaliar o PNB de 96 horas preditor de morte, e a regressão logística foi usada para avaliar um possível fator de confusão entre o PNB de 96 horas, a idade e o resultado. RESULTADOS: Havia um aumento no PNB de 96 horas (148 na admissão contra 267 após 96 horas; p = 0,04). Treze pacientes morreram. Para o corte 300 pg/mL, o PNB de 96 horas foi um preditor de morte (sensibilidade, 92,30%; especificidade, 77,80%; valor preditivo positivo, 66,70%; valor preditivo negativo, 95,50%). A área sob a curva ROC foi de 0,92. Foi observado um aumento de 7,4 vezes no risco relativo de morte em quatro anos com um PNB de 96 horas > 300 pg/mL (95% CI 1,90 a 29,30 p < 0,01). Foi observada uma associação entre o PNB de 96 horas e o Escore de Risco TIMI (p < 0,01). Foi observada uma associação entre o aumento no PNB de 96 horas e a doença multiarterial (p = 0,02). CONCLUSÃO: Na Scasest com troponina positiva, o PNB de 96 horas pode ser uma ferramenta de estratificação de risco. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: The prognostic value of BNP in acute coronary syndrome (ACS) has been repeatedly assessed, but not completely well established. Literature data for establishing the best time for assessing BNP, be it on hospital admission or after coronary intervention, are controversial. OBJECTIVE: To analyze BNP in non-ST segment elevation ACS (NSTE-ACS) in the long term, and to assess the association between BNP (pg/ml), death, coronary anatomy, and TIMI Risk Score. METHODS: Forty patients with NSTE-ACS and troponin>0.50 ng/ml had their BNP levels measured on admission and 96 hours after, and were followed up for four years. The difference between the two measures was assessed by use of Wilcoxon test (p<0.05). The ROC curve was used to evaluate 96-hour BNP accuracy as a death predictor, and logistic regression was used to assess a possible confounding factor among 96-hour BNP, age, and outcome. RESULTS: There was an increase in the 96-hour BNP (148 on admission vs. 267 after 96 hours; p=0.04). Thirteen patients died. For the 300 pg/ml cutoff, 96-hour BNP was a death predictor (sensitivity, 92.30%; specificity, 77.80%; positive predictive value, 66.70%; negative predictive value, 95.50%). The area under the ROC curve was 0.92. A 7.4-time increase in the relative risk of death in four years was observed with a 96-hour BNP> 300 pg/ml (95% CI 1.90 a 29.30 p<0.01). An association between 96-hour BNP and TIMI Risk Score was observed (p<0.01). An association was observed between the increase in 96-hour BNP and multivessel disease (p=0.02). CONCLUSION: In NSTE-ACS with positive troponin, 96-hour BNP can be a tool for risk stratification. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).