Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema

Background

Congestive heart failure is a common cardiac disorder associated with a high mortality. There are a limited number of prognostic scales predicting in-hospital outcomes after an acute episode of congestive heart failure.

Objectives

The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema.

Methods

We retrospectively studied 276 consecutive patients hospitalized with acute pulmonary edema from the years 1998 to 2000.

Results

During the initial hospitalization, 58 patients (21%) died and 218 patients (79%) were discharged. Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm³ on presentation. The presence of each factor was scored as 1 point, and the absence was scored as 0 points. The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%.

Conclusions

The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.