The ABIC score for Assessing Long-term Outcomes in Elderly Hospitalized Patients with Acute Exacerbations of Chronic Heart Failure

Objectives: Age-bilirubin-international normalized ratio -creatinine (ABIC) score was originally proposed as a tool to assess alcoholic hepatitis survival and to identify patients who respond to corticosteroid treatment. Since the components of this score are associated with prognosis in patients with heart failure, the purpose of this study was to determine the relationship between ABIC score and long-term prognosis of elderly patients with acute exacerbation of chronic heart failure. Methods: This is a retrospective cohort study of elderly patients with acute exacerbation of chronic heart failure who were hospitalized for the first time in the Second Affiliated Hospital of Chongqing Medical University from February 2017 to December 2017. The main clinical outcome was all-cause mortality within three years. Cox regression and Lasso regression were used to screen variables and build a prognostic model. Combined with the ABIC score, the final model was adjusted, and the predictive ability of the model was evaluated. The screened variables with ABIC score were incorporated into the multivariate Cox regression analysis and a nomogram prediction model was built. The receiver operating characteristic curve and calibration curve were used to evaluate the predictive ability and accuracy of the model, respectively. Results: A total of 365 patients with acute exacerbation of chronic heart failure were included (median age 78 years, 50.7% female). During the 3-year follow-up period, 87 patients experienced all-cause death, including 53 cardiac deaths. A total of 4 variables (NT-proBNP, BUN, RDW-CV and prealbumin) were screened by univariate Cox regression analysis and Lasso regression analysis. The multivariate COX regression results showed that the risk of death increased by 33% with the increase of ABIC score by 1 point (after correcting NT-proBNP, BUN, RDW-CV and prealbumin). The results of ROC curve analysis show that the area under the curve (AUC) of the ABIC score is 0.685, while the AUC of the Nomograph including the ABIC score is 0.840. Conclusions: The ABIC score is associated with long-term adverse outcomes in elderly hospitalized patients with chronic heart failure exacerbations. But its predictive ability for adverse events needs further exploration.