The predictive significance of the hlm score in heart failure

Background

Heart failure (HF) is a highly prevalent disease, with high morbidity and mortality. Scales for predicting death in patients with HF are continuously evolving, and risk prediction is a cornerstone of HF management. The last time, several scores have been devised to aid clinicians in assessing patient prognosis and help improve treatment. We use the scale HLM refers to heart damage (H), lung involvement (L), and malfunction of peripheral organs.

Purpose

The aim of the study was to perform a preliminary evaluation of the HLM score to determine its efficacy in the prognosis of patients with heart failure, based on their rehospitalization and mortality rates.

Methods

We conducted a retrospective cohort study involving 1.013 adult patients diagnosed with chronic heart failure (men 58%, age 72±12 years (M±SD), AH 93%, history of MI 39%, AF 56%, EF 44 (33;54) %, EF<40% 43%, baseline NT-proBNP 1745 (794;3414) pg/ml).

We evaluated various parameters for heart (H): (systolic and diastolic left ventricular function and structural damage, left ventricular dilation, diastolic or systolic right ventricular dysfunction, TAPSE), lungs (L): (hemodynamic or clinical pulmonary congestion, cardiac lung) and peripheral organs (M): (kidney, liver, central nervous system, and hematopoietic system) function have been examined. NYHA and HLM classification were performed in each patient.

Results

In our study, we found that the HLM 3-4 group presented more men compared to the HLM 1-2 group (64% vs 54%) p:0.001, higher creatinine levels (1.3 vs 1.14) mg/dL p:<0.001, higher NT-proBNP levels (2457 vs 1256) pg/ml p:< 0.001.

At 36 months follow-up, comparing to NYHA, HLM showed a greater area under the ROC curve (AUC) for death, (HLM AUC= 0.66 vs NYHA AUC= 0.57). Cardiac death and rehospitalization has been assessed separately for each parameter (H, L and M): L and M showed the most accurate prognostic power; at 3 years follow-up, H (p=0.009, OR= 1.89) L2 (p=0.03, OR= 3.13) and M (p=0.001, OR= 3.23). Kaplan-Meyer curves (for primary outcome mortality), in patients in the group H3-H4, show significant [Log Rank test p=0,0017, HR=2.12 (95% CI,1.31-3.42)].

Conclusion

The HLM score is more accurate in stratifying the risk of rehospitalization and cardiac death in patients with HF than the NYHA classification. A more comprehensive and systemic regard is suggested in patients with HF to assess prognosis.KAPLAN MEIERFor image description, please refer to the figure legend and surrounding text.