CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 42 AFRICA The AUC of BNP was 0.824 (95% CI 0.731–0.875, p < 0.001), the optimal critical value was 413.23 ng/ml, the Youden index was 0.62, the sensitivity was 0.836%, and the specificity was 0.732%. The AUC values of MEWS, cTnI and BNP were similar, exhibiting high predictive values for the prognosis of patients (Fig. 1). Discussion CHF is characterised as a severe, recurring condition with a high fatality rate, and clinically manifests as heart failure caused by left ventricular dysfunction, which is associated with underlying diseases such as hypertension and coronary heart disease. Older people have weakened organ function and many complications, so they are prone to CHF.16,17 Searching for reliable indices for assessing the severity of disease and predicting the long-term prognosis, and close monitoring and intervention for high-risk groups are the key to reducing the mortality rate and raising the quality of life of older patients with CHF.18 However, there are few markers for prognostic evaluation currently, or they have low accuracy, sensitivity and specificity, so their predictive value for prognosis is low. Therefore, markers valuable for long-term prognostic prediction are urgently needed. The MEWS scoring system, through comprehensive scoring of a patient’s systolic blood pressure, heart and respiration rate, body temperature and consciousness, and transformation of the severity of disease into scores, can quickly predict the severity of disease, unrestricted by instruments, personnel and sites. It is easily operated and widely used in the emergency department and intensive care unit.19,20 NYHA functional classification not only assesses the cardiac function, but also serves as an objective index to judge the condition of heart failure.21 In our study, the MEWS was determined in patients with different NYHA grades before and after treatment. It was found that the MEWS on discharge was significantly lower than that on admission in the four groups, and the higher the NYHA grade, the higher the MEWS. This is consistent with the findings of van der Woude et al.15 that the levels of soluble suppression of tumorigenesis-2 (sST2) and N-terminal pro-Btype natriuretic peptide (NT-proBNP) rose with the increase in NYHA grade. It can be seen that the MEWS was able to reflect the severity of impaired cardiac function in older patients. Moreover, the results in this study showed that NYHA grade and MEWS were the influencing factors for the clinical outcome of patients, and patients with a higher MEWS were more likely to die, indicating that MEWS can reflect the severity of CHF. To further evaluate the assessment value of the MEWS for the long-term prognosis of patients, it was subjected to ROC curve analysis. It was found that the AUC was 0.852, and the optimal cut-off value, sensitivity and specificity of MEWS in judging the condition of patients were 5.6 points, 0.854 and 0.797%, respectively, suggesting that MEWS has certain predictive value for the long-term prognosis of CHF. This cut-off value was basically consistent with that predicted by Chen et al.22 (5.3 points) for the prognosis of older patients with severe pneumonia and that predicted by Xie et al.23 (5 points) for patients with acute cerebral haemorrhage. Control of various complications and targeted care are necessary.24 This study, however, was a single-centre study with a small sample size, leading to certain limitations, so further multicentre, large-sample studies are needed for validation. Conclusions The MEWS increased with an increase in NYHA grade, and it could reflect the severity of CHF in these older patients. This meant it has higher predictive value for the long-term prognosis of patients, and can be used to assess the severity of CHF, help develop effective intervention strategies based on specific quantitative values, and provide a theoretical basis. References 1. Špinar J, Špinarová L, Vítovec J. Pathophysiology, causes and epidemiology of chronic heart failure. Vnitr Lek 2018; 64(9): 834–838. 2. Rogers C, Bush N. Heart failure: pathophysiology, diagnosis, medical treatment guidelines, and nursing management. Nurs Clin North Am 2019; 50(4): 787–799. 3. Jankowska-Polańska B, Świątoniowska-Lonc N, Sławuta A, et al. Patient-reported compliance in older age patients with chronic heart failure. PloS One 2020; 15(4): e0231076. 4. Liguori I, Russo G, Curcio F, et al. Depression and chronic heart failure in the elderly: an intriguing relationship. J Geriatr Cardiol 2018; 15(6): 451–459. 5. Ceriani E, Casazza G, Peta J, et al. Residual congestion and long-term prognosis in acutely decompensated heart failure patients. Intern Emerg Med 2020; 15(4): 719–724. 6. Cosansu K, Üreyen Ç M. Comments to “Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure”. J Geriatr Cardiol 2017; 14(10): 657–658. 7. Alcidi G, Goffredo G, Correale M, et al. Brain natriuretic peptide MEWS eTnI BNP 0.0 0.2 0.4 0.6 0.8 1.0 1 – Specificity 1.0 0.8 0.6 0.4 0.2 0.0 Sensitivity Fig. 1. ROC curves of MEWS, cTnI and BNP for predicting long-term prognosis.
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