The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Data Collection
2.3. Endpoints
2.4. Statistical Analysis
2.5. Ethics
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics (n/%) | Total Patients (2333/100%) | Survived (2092/89.67%) | Died (241/10.33%) | p-Value |
---|---|---|---|---|
Age (years) | 76.53 ± 14.27 | 75.88 ± 14.40 | 82.20 ± 11.70 | <0.01 |
Sex (Male) | 1259 (53.96) | 1130 (54.01) | 129 (53.53) | 0.89 |
Triage | 2 (2–3) | 2 (2–3) | 2 (1–2) | <0.01 |
Vital signs | ||||
SBP (mmHg) | 143.87 ± 32.47 | 145.06 ± 32.32 | 133.60 ± 31.95 | <0.01 |
DBP (mmHg) | 79.07 ± 19.9 | 79.76 ± 19.80 | 73.10 ± 19.87 | <0.01 |
MAP (mmHg) | 100.33 ± 21.85 | 101.19 ± 21.71 | 92.90 ± 21.68 | <0.01 |
Heart rate (beats/min) | 93.38 ± 24.4 | 93.04 ± 24.01 | 96.37 ± 27.45 | 0.07 |
Body temperature (°C) | 36.72 ± 0.77 | 36.70 ± 0.75 | 36.83 ± 0.95 | 0.05 |
Respiratory rate (/min) | 21.77 ± 4.24 | 21.22 ± 3.85 | 26.58 ± 4.42 | <0.01 |
SpO2 (%) | 93.76 ± 7.32 | 94.16 ± 6.70 | 90.36 ± 10.80 | <0.01 |
GCS score | 15 (15–15) | 15 (15–15) | 15 (11–15) | <0.01 |
Score | ||||
RAM | 17.50 ± 6.44 | 16.69 ± 5.83 | 24.58 ± 7.16 | <0.01 |
SI | 0.68 ± 0.24 | 0.67 ± 0.23 | 0.76 ± 0.30 | <0.01 |
MSI | 0.96 ± 0.31 | 0.95 ± 0.29 | 1.08 ± 0.39 | <0.01 |
ASI | 51.77 ± 20.31 | 50.59 ± 19.58 | 61.99 ± 23.49 | <0.01 |
AMSI | 73.63 ± 273.4 | 71.94 ± 26.25 | 88.35 ± 31.89 | <0.01 |
Age/MAP | 0.79 ± 0.24 | 0.79 ± 0.24 | 0.93 ± 0.24 | <0.01 |
Past History | ||||
Hypertension | 1616 (69.27) | 1480 (70.75) | 136 (56.43) | <0.01 |
Diabetes mellitus | 1049 (44.96) | 955 (45.65) | 94 (39.00) | 0.05 |
Heart disease * | 1953 (83.71) | 1749 (83.60) | 204 (84.65) | 0.68 |
Asthma or COPD | 582 (24.95) | 500 (23.90) | 82 (34.02) | <0.01 |
Chronic kidney disease | 1493 (63.99) | 1338 (63.96) | 155 (64.32) | 0.91 |
Cancer | 491 (21.05) | 416 (19.89) | 75 (31.12) | <0.01 |
Laboratory data | ||||
WBC (103 cells/mm3) | 9.54 ± 4.36 | 9.36 ± 4.12 | 11.06 ± 5.85 | <0.01 |
Hemoglobin (g/dL) | 11.40 ± 2.68 | 11.47 ± 2.68 | 10.80 ± 2.55 | <0.01 |
Platelet (103/mm3) | 219.74 ± 91.35 | 219.24 ± 88.79 | 224.05 ± 111.18 | 0.52 |
Sodium (mmol/L) | 134.74 ± 6.33 | 134.87 ± 5.94 | 133.64 ± 8.95 | 0.04 |
Potassium (mmol/L) | 4.20 ± 0.77 | 4.17 ± 0.74 | 4.47 ± 0.95 | <0.01 |
BUN (mg/dL) | 41.27 ± 28.11 | 40.31 ± 27.54 | 49.54 ± 31.53 | <0.01 |
Creatinine (mg/dL) | 2.43 ± 2.44 | 2.44 ± 2.51 | 2.41 ± 1.79 | 0.80 |
ALT (IU/L) | 39.56 ± 127.14 | 38.46 ± 129.36 | 49.15 ± 105.64 | 0.15 |
Troponin I (ng/mL) | 0.48 ± 2.12 | 0.42 ± 1.83 | 0.92 ± 3.68 | 0.24 |
hs-Troponin T (ng/L) | 144.84 ± 397.04 | 129.32 ± 344.85 | 285.16 ± 699.12 | <0.01 |
Echocardiography | ||||
EF | 47.16 ± 18.74 | 47.07 ± 18.83 | 47.94 ± 17.92 | 0.49 |
Admission † | ||||
Ward days | 9 (5–15) | 9 (5–15) | 8 (2–19) | 0.01 |
ICU days | 0 (0–2) | 0 (0–2) | 0 (0–10) | <0.01 |
Adjusted Odds Ratio | 95% CI | p-Value | AUROC | |
---|---|---|---|---|
RAM | 3.47 | 2.89–4.16 | <0.01 | 0.85 |
SI | 2.26 | 1.94–2.62 | <0.01 | 0.75 |
MSI | 2.28 | 1.96–2.65 | <0.01 | 0.75 |
ASI | 2.29 | 1.97–2.66 | <0.01 | 0.75 |
AMSI | 2.32 | 1.99–2.70 | <0.01 | 0.76 |
Age/MAP | 2.19 | 1.89–2.54 | <0.01 | 0.75 |
Adjusted Odds Ratio | 95% CI | p-Value | |
---|---|---|---|
RAM > 18.6 | 8.15 | 5.88–11.30 | <0.01 |
SI > 0.77 | 2.11 | 1.60–2.78 | <0.01 |
MSI > 1.11 | 2.41 | 1.83–3.18 | <0.01 |
ASI > 62.7 | 2.85 | 2.17–3.75 | <0.01 |
AMSI > 79.9 | 2.88 | 2.20–3.77 | <0.01 |
AUROC | 95% CI | SE | |
---|---|---|---|
RAM > 18.6 | 0.81 | 0.79–0.83 | 0.02 |
SI > 0.77 | 0.75 | 0.72–0.77 | 0.02 |
MSI > 1.11 | 0.75 | 0.73–0.77 | 0.02 |
ASI > 62.7 | 0.74 | 0.72–0.76 | 0.02 |
AMSI > 79.9 | 0.75 | 0.73–0.77 | 0.02 |
Performance | RAM > 18.6 |
---|---|
Sensitivity | 0.80 (0.74–0.85) |
Specificity | 0.68 (0.65–0.70) |
Positive predictive value | 0.22 (0.21–0.24) |
Negative predictive value | 0.97 (0.96–0.97) |
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© 2024 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Chang, Y.; Peng, C.-H.; Chen, J.-H.; Lee, Y.-T.; Wu, M.-Y.; Chung, J.-Y. The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department. Medicina 2024, 60, 1423. https://doi.org/10.3390/medicina60091423
Chang Y, Peng C-H, Chen J-H, Lee Y-T, Wu M-Y, Chung J-Y. The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department. Medicina. 2024; 60(9):1423. https://doi.org/10.3390/medicina60091423
Chicago/Turabian StyleChang, Yu, Chan-Huan Peng, Jiann-Hwa Chen, Yu-Ting Lee, Meng-Yu Wu, and Jui-Yuan Chung. 2024. "The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department" Medicina 60, no. 9: 1423. https://doi.org/10.3390/medicina60091423