Predicting recurrent hospitalizations and mortality in heart failure patients using the endothelial activation and stress index (EASIX) score
E Eliger, Y N Granot, K L Rozenfeld, O HavakukAbstract
Background
Heart failure (HF) is a major cause of mortality and morbidity, with early post-discharge readmission serving as a critical indicator of poor prognosis and high healthcare burden. Endothelial dysfunction plays a central role in HF progression and organ damage. The EASIX score (LDH X Creatinine / Platelets) is a simple, validated biomarker of endothelial stress. While its prognostic value is established in other clinical settings, its utility in predicting short-term outcomes specifically in acute HF is not well-defined.
Purpose
To investigate the ability of admission EASIX score for predicting 30-day all-cause mortality and readmissions in a large cohort of hospitalized HF patients.
Methods
We analyzed 6,832 patients hospitalized for HF at a tertiary center (2010–2020). EASIX was calculated within 24 hours of admission. Patients were stratified into quartiles (Q1: <1.80, Q2: 1.80–2.73, Q3: 2.74–4.39, Q4: >4.40). Primary outcomes were 30-day mortality and readmission rates.
Results
The study population had a mean age of 76.5± 12.1 years, (55% male, 38% with reduced systolic function). Elevated EASIX scores demonstrated a strong, independent association with adverse outcomes:30- Day Mortality Rates: Increased progressively from 7.5% in the lowest quartile (Q1) to 19.9% in the highest quartile (Q4) (p < 0.001).30- Day Readmission: Patients in Q4 had a significantly higher readmission compared to Q1 (Q4: 23.8% vs. Q1: 19.6%; p = 0.012).Multivariable Analysis: After adjusting for clinical variables (including Hb, CRP, WBC, Gender, HTN and lipids), the highest EASIX quartile (Q4) remained a robust independent predictor for both outcomes:30-Day Mortality: Adjusted Odds Ratio (OR) of 2.75 (95% CI 2.22–3.39, p < 0.001).30-Day Readmission: Adjusted Odds Ratio (OR) of 1.29 (95% CI 1.10-1.50, p = 0.001).
Conclusion
The EASIX score is a simple, cost-effective, and readily available tool for early risk stratification in HF. High EASIX scores at admission identify patients at increased risk for early post-discharge mortality and readmission, potentially guiding more intensive follow-up and management strategies.