HLM Score of Severino et al for a Patient with Heart Failure

Severino reported the HLM score to evaluate a patient with heart failure. The authors are from multiple institutions in Italy.

Patient selection: heart failure

HLM refers to heart, lungs and malfunction of other organs.

Heart	H Code
(diastolic dysfunction and/or structural cardiac damage) AND LVEF >= 50%	H1
(LVEF < 50%) OR (diastolic dysfunction) with structural damage) without LV dilatation	H2
[(LVEF < 50%) OR (diastolic dysfunction) with structural damage with LV dilatation] OR [right ventricular systolic dysfunction (TAPSE < 17 mm)]	H3
biventricular systolic dysfunction (LVEF < 50% AND TAPSE < 17 mm)	H4

where:

• Right ventricular systolic dysfunction is associated with TAPSE (tricuspid annular plane systolic excursion) < 17 mm.

Lungs	L Code
none	L0
hemodynamic involvement and/or elevated sPAP at rest without clinical signs of lung congestion	L1
clinical signs of lung congestion and increased left ventricular filling pressure	L2
"cardiac lung" (arterialization of pulmonary vasculature with post-capillary hypertension	L3

where:

• Clinical signs of lung congestion: crepitations, raised jugular venous pressure, orthopnea, dyspnea, need for supplemental oxygen

Organ Malfunction	Finding
kidney	GFR < 60 mL per min
Liver	>= 1 liver function tests >= 2 times ULN
Anemia	hemoglobin < 13 g/dL for male or < 12 g/dL for female; OR iron deficiency
Cachexia (nutritional status)	weight loss > 5% (unrelated to edema) in past year
CNS	stroke or other CNS involvement
psychiatric	depression or anxiety

HLM score =

= (2 * (H code)) + (3 * (L code)) + (M code)

Interpretation:

• minimum score: 2

• maximum score: 20

• The higher the score the worse the composite outcome.

Performance:

• The area under the ROC curve for all cause death or rehospitalization due to heart failure was 0.65.

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