Validation of Saiful Anwar Clinical Congestion Score in Comparison with NT-proBNP for Prediction of Short-term Outcome in Acute Heart Failure with Reduced Ejection Fraction

Background: Risk stratification of acute heart failure (AHF) patients during hospital admission utilizing clinical scores emerges as an alternative to standard natriuretic peptide measurement. The development of Saiful Anwar clinical congestion score (SACS) as a multivariable predictive model for prediction of short-term outcome in AHF with reduced ejection fraction (AHF-rEF) requires validation in comparison to NT-proBNP. Objective: To validate prognostic value of SACS compare with NT-proBNP in AHF-rEF Method: This single-center, prospective cohort study was held in dr. Saiful Anwar General Hospital during January 2019 to June 2020. From total 89 AHF-rEF patients who admitted to emergency department, were assigned to SACS prospective questionnaire fulfillment and NT-proBNP measurement during first 12-hours since admission. Patients were divided into two groups based on SACS score and NT-proBNP value during admission. 90-days follow up was performed after index hospitalization with outcome of interest i.e all-cause mortality (ACM) and HF-related rehospitalization (HFR). Discussion: NT-proBNP level >5180 pg/mL at admission was recognized as an independent predictor for short-term outcome in AHF; which is similar with the cut-off point expressed in our study [6]. In our study, performance of SACS ≥6 has shown fair discriminative ability with sensitivity 71% and specificity 78% for prediction of 90-days ACM, almost similar to the result found in standard biomark-er NT-proBNP ≥5000 pg/mL (sensitivity 71% and specificity 80%). Additive value of NT-proBNP significantly increase the discriminative ability of SACS with sensitivity 86% and specificity 81% for predict 90-days ACM Results: ACM and HFR rate in this study were 16.8% and 22.5%, respectively. SACS ≥6 demonstrated higher ACM and HFR rate during 90-days follow-up compared to SACS <6 (p=0.000; p=0.000, respectively). Performance of SACS ≥6 on admission showed good discriminative power for predicting 90-days ACM and HFR (AUC 0.841, p=0.000; AUC 0.788, p=0.000, respectively) compared to NT-proBNP ≥5000pg/mL (AUC 0.812, p=0.000; AUC 0.819, p=0.000, respectively). Additive value of NT-proBNP ≥5000pg/mL on top of SACS ≥6 increases discriminative power for predicting 90-days ACM and HFR after index hospitalization (AUC 0.836, p=0.000; AUC 0.90, p=0.000, respectively). Conclusion: SACS has demonstrated prognostic value compared to NT-proBNP for prediction of 90-days ACM and HFR after index hospitalization in AHF-rEF patients.