Mortality risk scores in acute cardiogenic pulmonary edema: a comparative study

Background: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening clinical condition frequently associated with unplanned hospital admissions and recurrent emergency department visits. Several prognostic risk scores have been developed to predict early mortality in patients with ACPE. This study aimed to compare the discriminative performance of established risk scores and to determine the most applicable tool for clinical use, as early identification of high-risk patients may support timely and effective management. Methods: In this single-center retrospective cohort study, 508 patients diagnosed with ACPE and admitted to a tertiary care hospital between January 2023 and January 2024 were included. Four prognostic scores, the SABIHA (systolic blood pressure, age, blood urea nitrogen, intubation, heart rate, and anemia) score, the Three Interventions in Cardiogenic Pulmonary Oedema (3CPO) trial score, the Prognostic Risk Score (PRS), and the Pulmonary Edema Prognostic Score (PEPS), were calculated for each patient. The primary outcome was 30-day all-cause mortality. Discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis. Additionally, multivariable logistic regression was conducted to identify independent predictors of mortality. Results: The SABIHA score demonstrated the highest discriminative performance, with an area under the curve (AUC) of 0.855 (95% confidence interval (CI): 0.808–0.903, p < 0.001). The optimal cutoff value for the SABIHA score was 2.5, yielding a sensitivity of 70% and specificity of 88%. In comparison, the AUC for the 3CPO score was 0.701 (95% CI: 0.808–0.903, p < 0.001). The SABIHA score significantly outperformed the PRS, PEPS, and 3CPO scores (p < 0.001, DeLong’s test). Conclusions: Among the evaluated prognostic tools, the SABIHA score exhibited superior predictive accuracy for 30-day mortality in patients with ACPE. By integrating age, vital signs, laboratory parameters, and intubation status, the SABIHA score may facilitate early identification of high-risk patients, thereby supporting more informed clinical decision-making and improved patient outcomes.

Heart failure; Pulmonary edema; Mortality; Risk score

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