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. 2024 Mar 28;13(7):1961.
doi: 10.3390/jcm13071961.

CARDS, a Novel Prognostic Index for Risk Stratification and In-Hospital Monitoring

Siyu Liang  1 , Qing Chang  2 , Yuelun Zhang  3 , Hanze Du  1 , Huijuan Zhu  1 , Shi Chen  1 , Hui Pan  1
Affiliations

CARDS, a Novel Prognostic Index for Risk Stratification and In-Hospital Monitoring

Siyu Liang et al. J Clin Med. .

Abstract

Background: Sodium fluctuation is independently associated with clinical deterioration. We developed and validated a prognostic index based on sodium fluctuation for risk stratification and in-hospital monitoring. Methods: This study included 33,323 adult patients hospitalized at a tertiary care hospital in 2014. The first 28,279 hospitalizations were analyzed to develop the model and then the validity of the model was tested using data from 5044 subsequent hospitalizations. We predict in-hospital mortality using age, comorbidity, range of sodium fluctuation, and duration of sodium fluctuation, abbreviated as CARDS. Results: In-hospital mortality was similar in the derivation (0.6%) and validation (0.4%) cohorts. In the derivation cohort, four independent risk factors for mortality were identified using logistic regression: age (66-75, 2 points; >75, 3 points); Charlson comorbidity index (>2, 5 points); range of sodium fluctuation (7-10, 4 points; >10, 10 points); and duration of fluctuation (≤3, 3 points). The AUC was 0.907 (95% CI: 0.885-0.928) in the derivation cohort and 0.932 (95% CI: 0.895-0.970) in the validation cohort. In the derivation cohort, in-hospital mortality was 0.106% in the low-risk group (0-7 points), 1.076% in the intermediate-risk group (8-14 points), and 8.463% in the high-risk group (15-21 points). In the validation cohort, in-hospital mortality was 0.049% in the low-risk group, 1.064% in the intermediate-risk group, and 8.403% in the high-risk group. Conclusions: These results suggest that patients at low, intermediate, and high risk for in-hospital mortality may be identified by CARDS mainly based on sodium fluctuation.

Keywords: hypernatremia; hyponatremia; in-hospital mortality; monitoring; sodium fluctuation.

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Conflict of interest statement

Chen disclosed that this work was supported by the National Key R&D Program of China (2022YFC3600202, 2022YFC3600203)). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram of inclusion and exclusion criteria.
Figure 2
Figure 2
Receiver operating characteristics curve (a) and calibration curve (b) of the risk index for predicting in-hospital mortality in the validation cohort.
See this image and copyright information in PMC

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