Validation of Harborview Risk Score for Ruptured Abdominal Aortic Aneurysms in a 22-Year Retrospective Single- Centre Experience

Background: Among all the published risk scores, the Harborview Risk Score (HRS) is the only one that relies exclusively on preoperative variables that can be easily assessed at the bedside (age >76 years, creatinine concentration >2.0 mg/dL, systolic blood pressure ever <70 mm Hg and pH < 7.2 or international normalized ratio >1.8). This study has the aim of retrospectively evaluating the population of the ASST Grande Ospedale Metropolitano Niguarda (Milan) the accuracy of the HRS in Italy and of the modified Harborview Risk Score (mHRS) for the first time in Italy. Methods: A single-center, retrospective, observational study was performed. Information on patients treated for ruptured abdominal aortic aneurysms (rAAAs) between January 2002 and March 2024 at the ASST Grande Ospedale Metropolitano Niguarda, Milan (Italy) were collected. Results: Of the 180 patients treated for rAAA in our hospital during the 22-year study period, 158 met inclusion criteria for the HRS and 145 for the mHRS. Observed 30-day mortality using the HRS was 8.3%, 24.1%, 47%, 54.5%, and 100%, respectively, for a score from 0 to 4 (P value < 0.001). For the mHRS the 30-day mortality observed was 13.2%, 26.7%, 36.4%, 58.8%, and 100%, respectively, for a score from 0 to 4 (P value < 0.001). Receiver operating characteristic analysis revealed a slightly higher ability of the HRS to predict 30-day death (area under the curve = 0.732) than the mHRS (area under the curve = 0.682). Conclusion: The HRS can accurately predict 30-day mortality after repair of rAAAs, with a higher accuracy for the HRS than the mHRS. These scores represent valuable tools that may guide the clinical decision-making process and help predict futility in the preoperative setting for this morbid disease.