Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 3, June 2026, pages 170-180

Sardjito Cardiovascular Intensive Care Score as an Alternative to Mayo Cardiac Admission Risk Score for Predicting Mortality in Cardiovascular Intensive Care Patients

↓ Figure 1. Flow diagram demonstrating inclusion and exclusion criteria. Most of subjects were excluded due to incomplete data of anion gap. CICU: cardiovascular intensive care unit.

↓ Figure 2. Distribution of SCIENCE and M-CARS score. The mortality rate will increase along with the increase in SCIENCE and M-CARS points. CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; SCIENCE score: Sardjito Cardiovascular Intensive Care score.

↓ Figure 3. M-CARS and SCIENCE ROC curves of (a) CICU mortality outcome and (b) in-hospital mortality outcome. Analysis of discrimination quality with the M-CARS (green line) and SCIENCE score (red line) have significant values (P < 0.001). CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; ROC: receiver operating characteristic; SCIENCE score: Sardjito Cardiovascular Intensive Care score.

↓ Figure 4. (a) Calibration plot M-CARS towards the CICU mortality outcome. (b) Calibration plot M-CARS towards the in-hospital mortality outcome. (c) Calibration plot SCIENCE towards the CICU mortality outcome. (d) Calibration plot SCIENCE towards the in-hospital mortality outcome. The Hosmer–Lemeshow test (calibration plots) shows that the expected mortality value (red line) and the observed mortality value (blue line) do not differ significantly (P > 0.05) in the figure above. CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; SCIENCE score: Sardjito Cardiovascular Intensive Care score.

↓ **Table 1.** Basic Characteristics of the Study Population
Variable	Total (n = 1,503)	CICU mortality	P value	In-hospital mortality	P value
*Statistically significant difference (P < 0.05). BUN: blood urea nitrogen; CICU: cardiovascular intensive care unit; LVEF: left ventricle ejection fraction; M-CARS: Mayo Cardiac Admission Risk Score; RDW: red cell distribution width; SCAI: Society for Cardiovascular Angiography and Interventions; SCIENCE: Sardjito Cardiovascular Intensive Care; TAPSE: tricuspid annular plane systolic excursion.
Gender				0.033*			0.057
Men, n (%)	993 (66.1%)	295 (62.2%)	698 (67.8%)		357 (63.1%)	636 (67.9%)
Women, n (%)	510 (33.9%)	9 (37.8%)	331 (32.2%)		209 (36.9%)	301 (32.1%)
Age (median)	62 (18–99)			0.444	63 (20–94)	61 (18–99)	0.031*
≥ 60 years	879 (58.5%)	284 (59.9%)	595 (57.8%)		351 (62%)	528 (56.4%)
< 60 years	624 (41.5%)	190 (40.1%)	434 (42.2%)		215 (38%)	409 (43.6%)
Admission diagnosis
Acute heart failure, n (%)	623 (41.5%)	206 (43.5%)	417 (40.5%)	0.283	252 (44.5%)	371 (39.6%)	0.06
Shock/hemodynamic instability, n (%)	642 (42.7%)	322 (67.9%)	320 (31.1%)	0.001*	366 (64.7%)	276 (29.5%)	0.001*
Acute coronary syndrome, n (%)	999 (66.4%)	307 (64.5%)	692 (67.2%)	0.346	352 (62%)	647 (69%)	0.06
STEMI	708 (70.9%)	222 (72.3%)	486 (70.2%)		246 (69.9%)	462 (71.4%)
NSTEMI	273 (27.3%)	83 (27%)	190 (27.5%)		103 (29.3%)	170 (26.3%)
UAP	18 (1.8%)	2 (0.7%)	16 (2.3%)		3 (0.9%)	15 (2.3%)
Arrhythmia, n (%)	352 (23.4%)	108 (22.8%)	244 (23.7%)	0.693	127 (22.4%)	225 (44.5%)	0.486
Vascular emergency, n (%)	61 (4.1%)	24 (5.1%)	37 (3.6%)	0.180	30 (5.3%)	31 (3.3%)	0.058
Cardiac arrest, n (%)	203 (13.5%)	103 (21.7%)	100 (9.7%)	0.001*	112 (19.8%)	91 (9.7%)	0.001*
Comorbid
Respiratory failure, n (%)	422 (28.1%)	258 (54.4%)	164 (15.9%)	0.001*	286 (50.5%)	136 (14.5%)	0.001*
Pneumonia, n (%)	358 (23.8%)	136 (28.7%)	807 (78.4%)	0.003*	166 (29.3%)	192 (20.5%)	0.001*
Urinary tract infection, n (%)	157 (10.4%	56 (11.8%)	101 (9.8%)	0.239	71 (12.5%)	86 (9.2%)	0.039
Renal chronic disease, n (%)	60 (4%)	17 (3.6%)	43 (4.2%)	0.586	25 (4.1%)	37 (3.8%)	0.702
Sepsis, n (%)	52 (3.3%)	26 (5.5%)	22 (2.1%)	0.001*	31 (5.5%)	17 (1.8%)	0.001*
Acute non-hemorrhagic stroke, n (%)	84 (5.6%)	37 (7.8%)	47 (4.6%)	0.011*	47 (8.3%)	37 (3.9%)	0.001*
Hemorrhagic stroke, n (%)	4 (0.3%)	4 (0.8%)	0 (0%)	0.010*	4 (0.7%)	0 (0%)	0.020*
Invasive ventilation usage, n (%)	384 (25.5%)	264 (55.7%)	120 (11.7%)	0.001*	287 (50.7%)	97 (10.4%)	0.001*
Non-invasive ventilation usage, n (%)	61 (4.1%)	23 (4.9%)	38 (3.7%)	0.290	28 (4.9%)	33 (3.5%)	0.175
Echocardiography
LVEF				0.001*			0.001*
≤ 40%	699 (46.5%)	261 (55.1%)	438 (42.6%)		298 (52.7%)	401 (42.8%)
41–49%	262 (17.4%)	77 (16.2%)	185 (18%)		174 (18.6%)	262 (17.4%)
≥ 50%	542 (36.1%)	136 (28.7%)	406 (39.5%)		180 (31.8%)	362 (38.6%)
TAPSE				0.001*			0.001*
< 17 mm	588 (39.1%)	240 (50.6%)	348 (33.8%)		270 (47.7%)	318 (33.9%)
≥ 17 mm	915 (60.9%)	234 (49.4%)	681 (66.2%)		296 (52.3%)	619 (66.1%)
Laboratory
Creatinine (mg/dL)				0.001*			0.001*
≥ 1.5 mg/dL	810 (53.9%)	340 (71.7%)	470 (45.7%)		401 (70.8%)	409 (43.6%)
< 1.5 mg/dL	693 (46.1%)	134 (28.3%)	559 (54.3%)		165 (29.2%)	528 (56.4%)
BUN (mg/dL)				0.001*			0.001*
> 23 mg/dL	856 (57%)	349 (73.6%)	507 (49.3%)		418 (73.9%)	438 (46.7%)
≤ 23 mg/dL	647 (43%)	125 (26.4%)	522 (50.7%)		148 (26.1%)	499 (53.3%)
RDW (%)				0.001*			0.001*
> 14.3	556 (37%)	208 (43.9%)	348 (33.8%)		260 (45.9%)	296 (31.6%)
≤ 14.3	947 (63%)	266 (56.1%)	681 (66.2%)		306 (54.1%)	641 (68.4%)
Anion gap				0.001*			0.001*
> 14	835 (55.6%)	350 (73.8%)	485 (47.1%)			435 (46.4%)
≤ 14	668 (44.4%)	124 (26.2%)	544 (52.9%)			502 (53.6%)
Lactate (median)	2.2 (0.32–19)	3.25 (0.32–19.4)	1.93 (0.33–19.4)	0.001*		1.9 (0.33–19)	0.001*
Others
The use of circulatory support device/intra-aortic balloon pump, n (%)	17 (1.1%)	9 (1.9%)	8 (0.8%)	0.056	10 (1.8%)	7 (0.7%)	0.070
Renal replacement therapy, n (%)	73 (4.9%)	38 (8%)	35 (3.4%)	0.001*	47 (8.3%)	26 (2.8%)	0.001*
Braden skin score				0.001*			0.001*
≤ 12	350 (23.3%)	244 (51.5%)	106 (10.3%)		271 (47.9%)	79 (8.4%)
13–15	507 (33.7%)	199 (25.1%)	388 (37.7%)		147 (26%)	360 (38.4%)
> 15	646 (43%)	111 (23.4%)	535 (52%)		148 (26.1%)	498 (53.1%)
SCIENCE score				0.001*			0.001*
High risk (≥ 3)	858 (57.1%)	393 (82.9%)	465 (45.2%)		455 (80.4%)	403 (43%)
Low risk (< 3)	645 (42.9%)	81 (17.1%)	564 (54.8%)		111 (19.6%)	534 (57%)
M-CARS score				0.001*			0.001*
High risk (≥ 4)	715 (47.6%)	376 (79.3%)	339 (32.9%)		432 (76.3%)	283 (30.2%)
Low risk (< 4)	788 (52.4%)	98 (20.7%)	690 (67.1%)		134 (23.7%)	654 (69.8%)
Outcomes
CICU mortality	474 (31.5%)
Hospital mortality	566 (37.7%)

↓ Table 1. Basic Characteristics of the Study Population

Variable

Total (n = 1,503)

CICU mortality

P value

In-hospital mortality

P value

Yes (n = 474)

No (n = 1,029)

Yes (n = 566)

No (n = 937)

*Statistically significant difference (P < 0.05). BUN: blood urea nitrogen; CICU: cardiovascular intensive care unit; LVEF: left ventricle ejection fraction; M-CARS: Mayo Cardiac Admission Risk Score; RDW: red cell distribution width; SCAI: Society for Cardiovascular Angiography and Interventions; SCIENCE: Sardjito Cardiovascular Intensive Care; TAPSE: tricuspid annular plane systolic excursion.

Gender

0.033*

0.057

Men, n (%)

993 (66.1%)

295 (62.2%)

698 (67.8%)

357 (63.1%)

636 (67.9%)

Women, n (%)

510 (33.9%)

9 (37.8%)

331 (32.2%)

209 (36.9%)

301 (32.1%)

Age (median)

62 (18–99)

0.444

63 (20–94)

61 (18–99)

0.031*

≥ 60 years

879 (58.5%)

284 (59.9%)

595 (57.8%)

351 (62%)

528 (56.4%)

< 60 years

624 (41.5%)

190 (40.1%)

434 (42.2%)

215 (38%)

409 (43.6%)

Admission diagnosis

Acute heart failure, n (%)

623 (41.5%)

206 (43.5%)

417 (40.5%)

0.283

252 (44.5%)

371 (39.6%)

0.06

Shock/hemodynamic instability, n (%)

642 (42.7%)

322 (67.9%)

320 (31.1%)

0.001*

366 (64.7%)

276 (29.5%)

0.001*

Acute coronary syndrome, n (%)

999 (66.4%)

307 (64.5%)

692 (67.2%)

0.346

352 (62%)

647 (69%)

0.06

STEMI

708 (70.9%)

222 (72.3%)

486 (70.2%)

246 (69.9%)

462 (71.4%)

NSTEMI

273 (27.3%)

83 (27%)

190 (27.5%)

103 (29.3%)

170 (26.3%)

UAP

18 (1.8%)

2 (0.7%)

16 (2.3%)

3 (0.9%)

15 (2.3%)

Arrhythmia, n (%)

352 (23.4%)

108 (22.8%)

244 (23.7%)

0.693

127 (22.4%)

225 (44.5%)

0.486

Vascular emergency, n (%)

61 (4.1%)

24 (5.1%)

37 (3.6%)

0.180

30 (5.3%)

31 (3.3%)

0.058

Cardiac arrest, n (%)

203 (13.5%)

103 (21.7%)

100 (9.7%)

0.001*

112 (19.8%)

91 (9.7%)

0.001*

Comorbid

Respiratory failure, n (%)

422 (28.1%)

258 (54.4%)

164 (15.9%)

0.001*

286 (50.5%)

136 (14.5%)

0.001*

Pneumonia, n (%)

358 (23.8%)

136 (28.7%)

807 (78.4%)

0.003*

166 (29.3%)

192 (20.5%)

0.001*

Urinary tract infection, n (%)

157 (10.4%

56 (11.8%)

101 (9.8%)

0.239

71 (12.5%)

86 (9.2%)

0.039

Renal chronic disease, n (%)

60 (4%)

17 (3.6%)

43 (4.2%)

0.586

25 (4.1%)

37 (3.8%)

0.702

Sepsis, n (%)

52 (3.3%)

26 (5.5%)

22 (2.1%)

0.001*

31 (5.5%)

17 (1.8%)

0.001*

Acute non-hemorrhagic stroke, n (%)

84 (5.6%)

37 (7.8%)

47 (4.6%)

0.011*

47 (8.3%)

37 (3.9%)

0.001*

Hemorrhagic stroke, n (%)

4 (0.3%)

4 (0.8%)

0 (0%)

0.010*

4 (0.7%)

0 (0%)

0.020*

Invasive ventilation usage, n (%)

384 (25.5%)

264 (55.7%)

120 (11.7%)

0.001*

287 (50.7%)

97 (10.4%)

0.001*

Non-invasive ventilation usage, n (%)

61 (4.1%)

23 (4.9%)

38 (3.7%)

0.290

28 (4.9%)

33 (3.5%)

0.175

Echocardiography

LVEF

0.001*

≤ 40%

699 (46.5%)

261 (55.1%)

438 (42.6%)

298 (52.7%)

401 (42.8%)

41–49%

262 (17.4%)

77 (16.2%)

185 (18%)

174 (18.6%)

262 (17.4%)

≥ 50%

542 (36.1%)

136 (28.7%)

406 (39.5%)

180 (31.8%)

362 (38.6%)

TAPSE

0.001*

< 17 mm

588 (39.1%)

240 (50.6%)

348 (33.8%)

270 (47.7%)

318 (33.9%)

≥ 17 mm

915 (60.9%)

234 (49.4%)

681 (66.2%)

296 (52.3%)

619 (66.1%)

Laboratory

Creatinine (mg/dL)

0.001*

≥ 1.5 mg/dL

810 (53.9%)

340 (71.7%)

470 (45.7%)

401 (70.8%)

409 (43.6%)

< 1.5 mg/dL

693 (46.1%)

134 (28.3%)

559 (54.3%)

165 (29.2%)

528 (56.4%)

BUN (mg/dL)

0.001*

> 23 mg/dL

856 (57%)

349 (73.6%)

507 (49.3%)

418 (73.9%)

438 (46.7%)

≤ 23 mg/dL

647 (43%)

125 (26.4%)

522 (50.7%)

148 (26.1%)

499 (53.3%)

RDW (%)

0.001*

> 14.3

556 (37%)

208 (43.9%)

348 (33.8%)

260 (45.9%)

296 (31.6%)

≤ 14.3

947 (63%)

266 (56.1%)

681 (66.2%)

306 (54.1%)

641 (68.4%)

Anion gap

0.001*

> 14

835 (55.6%)

350 (73.8%)

485 (47.1%)

435 (46.4%)

≤ 14

668 (44.4%)

124 (26.2%)

544 (52.9%)

502 (53.6%)

Lactate (median)

2.2 (0.32–19)

3.25 (0.32–19.4)

1.93 (0.33–19.4)

0.001*

1.9 (0.33–19)

0.001*

Others

The use of circulatory support device/intra-aortic balloon pump, n (%)

17 (1.1%)

9 (1.9%)

8 (0.8%)

0.056

10 (1.8%)

7 (0.7%)

0.070

Renal replacement therapy, n (%)

73 (4.9%)

38 (8%)

35 (3.4%)

0.001*

47 (8.3%)

26 (2.8%)

0.001*

Braden skin score

0.001*

≤ 12

350 (23.3%)

244 (51.5%)

106 (10.3%)

271 (47.9%)

79 (8.4%)

13–15

507 (33.7%)

199 (25.1%)

388 (37.7%)

147 (26%)

360 (38.4%)

> 15

646 (43%)

111 (23.4%)

535 (52%)

148 (26.1%)

498 (53.1%)

SCIENCE score

0.001*

High risk (≥ 3)

858 (57.1%)

393 (82.9%)

465 (45.2%)

455 (80.4%)

403 (43%)

Low risk (< 3)

645 (42.9%)

81 (17.1%)

564 (54.8%)

111 (19.6%)

534 (57%)

M-CARS score

0.001*

High risk (≥ 4)

715 (47.6%)

376 (79.3%)

339 (32.9%)

432 (76.3%)

283 (30.2%)

Low risk (< 4)

788 (52.4%)

98 (20.7%)

690 (67.1%)

134 (23.7%)

654 (69.8%)

Outcomes

CICU mortality

474 (31.5%)

Hospital mortality

566 (37.7%)

↓ **Table 2.** Accuracy Test of SCIENCE and M-CARS Upon CICU and Hospital Mortality Outcomes
	Score category	Death	Alive	Sn (%)	Sp (%)	PPV (%)	NPV (%)	Accuracy (%)
CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; NPV: negative predictive value; PPV: positive predictive value; SCIENCE score: Sardjito Cardiovascular Intensive Care score; Sn: sensitivity; Sp: specificity.
CICU outcomes	M-CARS	High risk (≥ 4)	376	339	72.32	67.07	52.59	87.56	70.92
		Low risk (< 4)	98	690
	SCIENCE	High risk (≥ 3)	393	465	82.91	54.81	45.80	87.44	63.67
		Low risk (< 3)	81	564
Hospital outcomes	M-CARS	High risk (≥ 4)	432	283	76.33	69.80	60.42	82.99	72.26
		Low risk (< 4)	134	654
	SCIENCE	High risk (≥ 3)	455	403	80.39	56.99	53.03	82.79	65.80
		Low risk (< 3)	111	534

↓ Table 2. Accuracy Test of SCIENCE and M-CARS Upon CICU and Hospital Mortality Outcomes

Score category

Death

Alive

Sn (%)

Sp (%)

PPV (%)

NPV (%)

Accuracy (%)

CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; NPV: negative predictive value; PPV: positive predictive value; SCIENCE score: Sardjito Cardiovascular Intensive Care score; Sn: sensitivity; Sp: specificity.

CICU outcomes

M-CARS

High risk (≥ 4)

376

339

72.32

67.07

52.59

87.56

70.92

Low risk (< 4)

690

SCIENCE

High risk (≥ 3)

393

465

82.91

54.81

45.80

87.44

63.67

Low risk (< 3)

564

Hospital outcomes

M-CARS

High risk (≥ 4)

432

283

76.33

69.80

60.42

82.99

72.26

Low risk (< 4)

134

654

SCIENCE

High risk (≥ 3)

455

403

80.39

56.99

53.03

82.79

65.80

Low risk (< 3)

111

534

↓ **Table 3.** Discrimination Quality Test of SCIENCE and M-CARS
	Variable	AUC	P	95% CI
*Statistically significant difference (P < 0.05). AUC: area under the curve; CI: confidence interval; CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; SCIENCE score: Sardjito Cardiovascular Intensive Care score.
CICU mortality	M-CARS	0.804	< 0.001*	0.780	0.828
	SCIENCE	0.775	< 0.001*	0.751	0.800
In-hospital mortality	M-CARS	0.797	< 0.001*	0.773	0.820
	SCIENCE	0.767	< 0.001*	0.742	0.791

↓ Table 3. Discrimination Quality Test of SCIENCE and M-CARS

Variable

AUC

95% CI

Lower bound

Upper bound

*Statistically significant difference (P < 0.05). AUC: area under the curve; CI: confidence interval; CICU: cardiovascular intensive care unit; M-CARS: Mayo Cardiac Admission Risk Score; SCIENCE score: Sardjito Cardiovascular Intensive Care score.

CICU mortality

M-CARS

0.804

< 0.001*

0.780

0.828

SCIENCE

0.775

< 0.001*

0.751

0.800

In-hospital mortality

M-CARS

0.797

< 0.001*

0.773

0.820

SCIENCE

0.767

< 0.001*

0.742

0.791