Recently, the Harborview Risk Score (HRS) was presented as a potential clinical tool to predict the 30-day mortality after repair of ruptured abdominal aortic aneurysms (rAAA), that could guide treatment decision-making. The HRS assigns one point for each of the following preoperative characteristics: age >76 years, pH <7.2, creatinine level >2mg/dL (>176.8 µmol/L) and systolic blood pressure <70mmHg, resulting in a score from 0 to 4. The 30-day mortality risk increases with every point. The primary aim of this study was to validate the HRS in a European population, in order to work towards an accurate scoring tool that is applicable in emergency settings. Secondly, we aimed to identify other clinically relevant predictors for 30-day mortality after repair of rAAA.

In this single-center retrospective cohort study, data from patients who underwent open repair or endovascular aortic repair (EVAR) for an rAAA between January 2009 and February 2022 were collected. To validate the HRS, patients were grouped by HRS score and the 30-day mortality rate was calculated for each HRS group. HRS variables and other preoperative variables that potentially predict 30-day mortality were tested for significance in a univariable logistic regression model. A subsequent multivariable logistic regression analysis was performed including the HRS and other significant predictors.

In total, data from 135 eligible patients were included in the analysis. Open repair was performed in 95 patients and 40 patients underwent EVAR. The 30-day mortality rate for each HRS group is shown in Figure 1, that also includes the results from two previous studies for comparison. Univariate logistic regression analyses identified pH < 7.2, systolic blood pressure < 70mmHg, female sex, performance status an increasing HRS as significant risk factors for 30-day postoperative mortality (Table 1). After adjusting for sex and performance status in the multivariate analysis, the association between the HRS and 30-day mortality remained significant (OR 2.532 (95%CI:1.437-4.461)) (Table2).

The Harborview Risk Score was validated in this single-center European study and was concordant with data presented in earlier studies. Therefore, the HRS seems an accurate and accessible preoperative prediction tool for 30-day mortality in patients with rAAA. Our results suggest that female sex and performance status are also significant predictors for 30-day postoperative mortality, and should be assessed in other populations in order to improve preoperative scoring systems.

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