Creatinine clearance for prognosis of patietns with acute coronary syndrom

Shock Index-Creatinine Clearance score (SI-C) is a recently developed version of the shock index. These updated score includes renal function and has already been used in ST-Elevation Myocardial Infarction patients. However its utility in predicting outcomes for patients with Acute Coronary Syndrome (ACS) remains unclear. The aim of this study was to evaluate the interaction between SI-C and the in-hospital mortality in ACS patients.

A retrospective analysis of 528 patients admitted to a Cardiology ward diagnosed with ACS. Patients with chronic kidney disease were not included in this analysis. The SI-C was calculated from the data colected from the patient admission to the emergency room. The primary endpoint was defined as in-hospitality mortality. Analysis of significance was conducted using Chi-square analysis and Mann-Whitney U test. Receiver Operating Characteristic (ROC) curve analysis was conducted to evaluate the performance of SI-C in predicting the primary outcome. Patients were stratified into two groups based on the optimal cut-off value determined from ROC curve.

Mean patient age was 65.3 (±13.7) years; 78% were male; 9.8% of the patients died during hospital stay. No differences were found between SI-C regarding the presence of type 2 diabetes melitus (p=0.41), arterial hypertension (p=0.49), dyslipidemia (p=0.45), smoking habits (p=0.48), obesity (p=0.49) and previous coronary artery disease (p=0.29).

The SI-C score was significantly higher in the group of patients who deceased during hospital stay (15 ± 26 vs -14 ± 19, p<0,01). The predictive value of SI-C for in-hospitality mortality was good (area under the curve= 0.711, 95% CI: 0.633-0.789, p<0.001). After categorization of the SI-C, a high SI-C score (≥ 20) was associated with an odds ratio of 3.89 (2.09-7.30; 95% CIs).

SI-C had a good predictive value in-hospitality mortality of patients after ACS, particularly with a score ≥ 20.

ROC In-hospital mortality