TITLE:
The Diagnostic Value of H Formula to Predict Mortality in Hospitalized Patients with Infectious Diseases
AUTHORS:
Ali Akbar Heydari, Khosro Mohammadi, Saied Akhlaghi, Arash Arianpoor
KEYWORDS:
Mortality, Prediction, Infectious Disease, H Formula, Vital Signs
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.4 No.2,
June
9,
2014
ABSTRACT: The ability to identify patients with risk of mortality in the initial
stages allows us to introduce a more aggressive treatment in order to improve
patients’ survival. In this study, we used systemic inflammatory response
syndrome (SIRS) criteria, respiratory and heart rate per minute, and consciousness
level [(Glasgow coma scale (GCS)] to develop a formula to predict death in
patients admitted to the Infectious Diseases ward of Imam Reza hospital.
Methods: This descriptive study was a cross sectional study done in the
Infectious Diseases ward of Imam Reza hospital, Mashhad University of Medical
Sciences, Iran. Alive and dead patients between the dates September 1, 2006 to
September 1, 2007 were studied. In this study, data such as past medical
history, prescribed drugs and their administration by nursing and medical staff
was extracted from patients’ files. Also, the time of death, the first vital
signs recorded in the hospital and the formula H = (PR + RR) - GCS (respiratory
rate per minute plus heart rate per minute minus Glasgow coma scale (GCS)) was
calculated for both alive and dead patients. Data was analyzed by SPSS
software. Mann-Whitney test, Roc Curve, and logistic regression model were used
for data analysis. Results: The total number of admitted patients was 1007 of
whom 90 (10.82%) died. One patient was excluded from the study. Out of 90 dead
patients, 51 (56.6%) were male and 39 (43.3%) were female. There was no
significant difference between the two groups regarding the gender (P > 0.05).
The mean age of the study group (deceased) was 59 ± 21 and the mean age of the
control group (alive) was 58 ± 21. The Mann-Whitney test showed that the result
of H Formula was significantly different between the two groups, (126 ± 26 for
the study group and 111 ± 22 for the control group). The cutoff for H Formula was
equal to 112.5. Negative and positive predictive values, specificity and
sensitivity were 0.85, 0.35, 0.57, and 0.70 respectively. Logistic regression
results show that the H index contents independently affected the mortality of
infected patients. Conclusion: With regard to the importance of measuring vital
signs in diagnosis and determining the mortality in patients with infectious
disease, the H (Heydari) formula can be valuable for evaluation and
determination of mortality risk and consequently, early intervention. Patients
with severe tachycardia, severe tachypnea and altered mental status that cannot
be properly and quickly improved within 2 hours after admission via hydration
and other measures are at higher risk of mortality.