IJCS | Volume 33, Nº4, July and August 2020

DOI: https://doi.org/10.36660/ijcs.20190094 Introduction Acute myocardial infarction (AMI) is the main cause of death in the world and the prevalence is rising in developing countries. 1 According to previous studies, the mortality has been declining in higher-income countries, and it has generally been attributed to greater use of preventive measures, adherence to current guidelines and revascularization procedures. 1,2 A recent paper, published by our research group, showed that the 380 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2020; 33(4):380-388 Mailing Address: José Gildo de Moura Monteiro Júnior Pronto Socorro Cardiológico de Pernambuco (PROCAPE) - Unidade Coronária - 1º andar - Rua dos Palmares, s/n. Postal Code: 50.100-060, Santo Amaro, Recife, PE – Brazil. E-mail: jgildojunior@uol.com.br Performance of a Hematological Scoring System in Predicting All-Cause Mortality in Patients with Acute Myocardial Infarction José Gildo de Moura Monteiro Júnio r, D ilênia de Oliveira Cipriano Torre s, M aria Cleide Freire Clementino da Silv a, Tácio Rian Nogueira Príncip e, R hayssa Barbosa de Vasconcelo s, M aria Eduarda Cavalcanti de Brit o, Maria Alice Aquino Limeir a, Ana Célia Oliveira dos Santo s, U lisses Ramos Montarroyo s, D ário Celestino Sobral Filh o Universidade de Pernambuco (Campus Santo Amaro), Recife, PE – Brazil Manuscript received May 23, 2019; revised manuscript July 23, 2019; accepted September 25, 2019. Abstract Background: The presence of nucleated red blood cells (NRBCs) and increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) in peripheral circulation are associated with poorer prognosis in patients with acute coronary disease. Objective: We developed a scoring system for in-hospital surveillance of all-cause mortality using hematological laboratory parameters in patients with acute myocardial infarction (AMI). Methods: Patients admitted for AMI were recruited in this prospective study. Exclusion criteria were age younger than 18 years, glucocorticoid therapy, cancer or hematological diseases and readmissions. NRBCs, MPV and NLR were measured during hospitalization. The scoring system was developed in three steps: first, the magnitude of the association of clinical and laboratory parameters with in-hospital mortality was measured by odds ratio (OR), second, a multivariate logistic regression model was conducted with all variables significantly (p < 0.05) associated with the outcome, and third, a β-coefficient was estimated by multivariate logistic regression with hematological parameters with a p < 0.05. Results: A total of 466 patients (mean age were 64.2 ± 12.8 years, 61.6% male) were included in this study. A hematological scoring system ranging from 0 to 49, where higher values were associated with higher risk of in- hospital death. The best performance was registered for a cut-off value of 26 with sensitivity of 89.1% and specificity of 67.2%, positive predictive value of 26.8% (95% CI: 0.204 – 0.332) and negative predictive value of 97.9% (95% CI: 0.962 – 0.996). The area under the curve for the scoring system was 0.868 (95% CI: 0.818 – 0.918). Conclusions: Here we propose a hematological scoring system for surveillance tool during hospitalization of patients with acute myocardial infarction. Based on total blood count parameters, the instrument can evaluate inflammation and hypoxemia due to in-hospital complications and, consequently, predict in-hospital mortality. (Int J Cardiovasc Sci. 2020; 33(4):380-388) Keywords: Myocardial Infarction; Coronary Artery Diseases; Severity of Illness Index; Mortality; Scoring System; Nucleated Red Blood Cells; Mean Platelet Volume; Neutrophil to Lymphocyte Ratio.