Integrated Assessment of Biomarkers, Hemodynamic Parameters, and Comorbidities for Predicting Short-Term Mortality in Critically Ill Patients With Acute Cardiac Conditions Presenting to the Emergency Department

Background: Critically ill patients presenting with acute cardiac conditions have a high risk of short-term mortality.Early identification of high-risk patients may be improved by combining biomarkers, hemodynamic parameters, and comorbidity burden.Objective: To evaluate the integrated predictive value of biomarkers, hemodynamic parameters, and comorbidities for 30-day mortality in critically ill patients with acute cardiac conditions presenting to the emergency department.Methods: This retrospective observational cohort study was conducted at the Department of Cardiology, Punjab Institute of Cardiology, Lahore, from January 2025 till June 2025 and included 160 adult patients with acute cardiac conditions.Results: Of 160 patients, 34 (21.3%)died within 30 days.Non-survivors were older than survivors (72.91 ± 11.84 vs. 61.82± 13.21 years; p < 0.001) and had higher Charlson Comorbidity Index (CCI) scores (5.82 ± 2.01 vs. 3.61 ± 1.89; p < 0.001).They also had a higher shock index (1.27± 0.38 vs. 0.79 ± 0.22), lactate (5.18 ± 2.71 vs. 2.21 ± 1.34 mmol/L), and NT-proBNP levels, with a lower left ventricular ejection fraction (LVEF; 30.74 ± 9.63% vs. 41.62 ± 10.81%), all significantly different.Independent predictors of 30-day mortality included lactate >4 mmol/L (adjusted OR: 4.82), cardiogenic shock (OR: 4.36), LVEF <35% (OR: 3.44), shock index ≥1.0(OR: 3.21), CCI ≥5 (OR: 3.09), NT-proBNP >4,000 pg/mL (OR: 2.67), chronic kidney disease (OR: 2.41), and age ≥70 years (OR: 2.18).The integrated model showed the highest predictive accuracy (area under the ROC curve (AUC): 0.92) compared with hemodynamic parameters (0.84), biomarkers (0.81), and comorbidities alone (0.72).Conclusion: An integrated assessment of biomarkers, hemodynamic parameters, ventricular function, and comorbidity burden demonstrated excellent discriminatory performance for predicting 30-day mortality in critically ill patients with acute cardiac conditions (AUC: 0.92).Further prospective, multicenter validation and clinical impact studies are required to determine whether implementing this model improves clinical decision-making or patient outcomes.