Published Online
on October 30, 2009

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Original Article

The Development of a Simple Risk Score to Predict Early Outcome in Severe Acute Acidotic Cardiogenic Pulmonary Edema: The 3CPO Score

Alasdair Gray^1,6; Steve Goodacre²; Jon Nicholl²; Moyra Masson¹; Fiona Sampson²; Mark Elliott³; Steve Crane⁴ and David E. Newby⁵

¹ Royal Infirmary of Edinburgh, Edinburgh, UK;
² University of Sheffield, Sheffield, UK;
³ Leeds Teaching Hospitals Trust, Leeds, UK;
⁴ York Hospitals NHS Foundation Trust, York, UK;
⁵ University of Edinburgh, Edinburgh, UK

^* Corresponding author; email: alasdairgray{at}blueyonder.co.uk

Background—Acute cardiogenic pulmonary edema (ACPE) is a common medical emergency with high early mortality. Initial clinical assessment would benefit from accurate mortality prediction. We aimed to develop a simple clinical score based upon presenting characteristics that would predict 7-day mortality in patients with ACPE.

Methods and Results—We used data from patients recruited to the 3CPO trial (a pragmatic multicentre trial comparing continuous positive airway pressure , noninvasive positive pressure ventialition and standard oxygen therapy in Emergency Department patients with ACPE) to investigate the association between baseline characterisitics and 7-day mortality. Factors associated with mortality (P<0.1) were entered into a multivariable model. Independent predictors of mortality from the multivariable model (P<0.05) were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver-operator-characteristic (ROC) analysis. Data from 1069 patients (78±10 years; 43% male; 7-day mortality 9.6%) were analysed. Multivariable analysis identified age (P=0.003), systolic blood pressure (P<0.001) and Glasgow Coma Scale (GCS) motor component dichotomised and simplified to the ability to obey commands or not (P=0.02) as the only independent predictors of 7-day mortality. These were weighted and used to develop a risk score ranging from zero (7-day mortality 1.9%, 95% CI 0.8 to 4.5%) to seven (7-day mortality 100%, 95% CI 34.2 to 100%). ROC analysis demonstrated good risk prediction with a c-statistic of 0.794 (95% CI 0.745 to 0.843). A simplified 3-point score with no weighting had a c-statistic of 0.754 (95% CI 0.701 to 0.807).

Conclusion—A simple clinical score based on age, systolic blood pressure and the ability to obey commands predicts early mortality in patients with ACPE.

Key Words: edema • heart failure • mortality • prognosis • risk factors