الفهرس 
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Abstract
Heart failure (HF) is a major worldwide public health concern and the most common cause of hospitalization among elder patients. Many of these patients unfortunately died during hospital stay and many of them had multiple hospital readmission times with decompensated heart failure symptoms.
Many types of recently discovered cardiac biomarkers like BNP, NT Pro-BNP, HS troponin had shown an important value in diagnosis, prognosis and treatment of acutely decompensated heart failure. Also, heart failure is associated with elevated inflammatory markers like CRP, ESR and Serum albumin which had an important prognostic value. ECG findings like PR, QT, QRS intervals and presence or absence of bundle branch block beside echocardiographic measurements like left ventricular and left atrial volumes, all had an important value in predicting prognosis of heart failure patients.
Early diagnosis and Prediction of acute heart failure Patient prognosis is very important for several reasons. It can help to determine the intensity of initial treatment and monitoring, facilitate triage decisions, provide initial information to patients and relatives, and is also important for audit and retrospective quality control.
Risk scores are multivariable predictive models in which relative weights are assigned to each variable in order to calculate the probability that a specific event (death, rehospitalization) will occur in the future. They are tools that help doctors estimate prognosis in a more unbiased way, translating the result of prognostic studies in clinical practice.
This study aims to propose a new risk score for the mid-term prognosis of acutely decompensated heart failure patients within 6 months utilizing history taking, clinical features, laboratory markers, electrocardiographic and echocardiographic measurements for better prognosis of those patients.
Our study included 110 patients admitted to CCU department of Egypt-air hospital from November 2019 to November 2020 by acute decompensated heart failure symptoms according to ESC heart failure guidelines 2016, all of them were subjected to full history taking including age, gender and history of smoking, hypertension or diabetes mellitus then full clinical examination including heart rate, blood pressure measurements and presentation with cardiogenic shock or pulmonary oedema.
All the patients had done ECG with measuring of PR interval, QRS duration, QT interval and presence or absence of bundle branch block beside echocardiography with measuring of EF by Simpson’s method, left ventricular volume, left atrial volumes and TAPSE.
All the patients had done BNP, NT Pro-BNP, HS troponin, CRP, ESR, uric acid, albumin, LDH, total bilirubin and CBC including hemoglobin, neutrophils, eosinophils, lymphocytes, monocytes counts and neutrophils/lymphocytes ratio.
All Patients were followed up monthly for 6 months and were divided according to their clinical outcome into the 3 groups: (a) group I: Patients survived for 6 months without any re-hospitalization, (b) group II: Patients survived for 6 months with one or multiple rehospitalization with acute decompensated heart failure, (c) group III: Patients died during 6 months.
Our proposed score included 22 parameters:
• 4 qualitative data score (0, 1) which are: History of hypertension, presentation with pulmonary edema, presentation with cardiogenic shock and presence of bundle branch block.
• 12 quantitative data score (0, 1, 2) which are: Age, heart rate, systolic and diastolic blood pressure, BNP, NT Pro-BNP, CRP, hemoglobin count, monocytes count, neutrophils count, EF by Simpson’s method and TAPSE.
• 6 quantitative data score only (0, 1) which are: Uric acid level, total bilirubin level, PR interval, QRS duration, left ventricular volume and left atrial volume as their cutoff between no re-hospitalization group versus rehospitalization group was the same like their cutoff between alive and dead groups.
Our proposed score showed some non-significant parameters which were excluded from the score like sex, history of DM or dyslipidemia or smoking, HS troponin, ESR, albumin, LDH, eosinophils, lymphocytes, neutrophils /lymphocytes ratio and QT interval.
Our proposed score showed a total maximum score of 34 points and by applying the scoring system to our patient groups retrospectively it was found that group I scored between 4 to 23, group II scored between 12 to 31 and group III scored between 19 to 31.
Then according to the previous scores, patients were divided into 3 groups; score (<12) = High probability group of no re-hospitalization nor death during 6 months, score (≥ 12 - < 19) = High probability group of re-hospitalization during 6 months, score (≥ 19) = High probability group of death during 6 months.
The first cutoff (12) between no re-hospitalization group versus both re-hospitalization and dead groups showed a sensitivity of 100% and specificity of 29.26%, its ability to predict serious cases (re-hospitalization and death) was 70.4% and its ability to predict non serious cases (no re-hospitalization) was 100 %; total evaluation of this cutoff was 73.63%.
The second cutoff (19) between alive group versus died group showed a sensitivity of 100% and specificity of 72.83%, its ability to predict serious cases (death) was 56.86% and its ability to predict non serious cases (alive) was 100%; total evaluation of this cutoff was 80%.
A new easy, applicable and not time-consuming score for early prognosis of acute heart failure patients was established using laboratory tests, ECG measurements and Echocardiographic parameters.