التفاصيل البيبلوغرافية
| العنوان: |
Creation of a Quantitative Recipient Risk Index for Mortality Prediction After Cardiac Transplantation (IMPACT). |
| المؤلفون: |
Weiss, Eric S., Allen, Jeremiah G., Arnaoutakis, George J., George, Timothy J., Russell, Stuart D., Shah, Ashish S., Conte, John V. |
| المصدر: |
Annals of Thoracic Surgery; Sep2011, Vol. 92 Issue 3, p914-922, 9p |
| مصطلحات موضوعية: |
HEART transplantation complications, MORTALITY, RISK assessment, ALLOCATION of organs, tissues, etc., REGRESSION analysis, COHORT analysis, MEDICAL statistics |
| مستخلص: |
Background: No recipient risk index exists predicting short-term mortality after orthotopic heart transplantation (OHT). We utilized United Network for Organ Sharing (UNOS) data to develop a novel quantitative recipient risk score for use in OHT. Methods: A prospectively collected open cohort of 21,378 primary OHT patients (1997 to 2008) was randomly divided into subgroups. The training cohort (n = 17,079) was used for score derivation and the test cohort (n = 4,299) was used for independent validation. Recipient specific variables associated with 1-year mortality (exploratory p value < 0.2) were incorporated stepwise into a multivariable logistic regression model. The final model contained variables which maximized explanatory power (assessed by pseudo R2, area under the curve, and likelihood-ratio test). A risk index was created by apportioning points approximating the relative impact of variables on 1-year mortality. The Kaplan-Meier method was used to assess impact of risk score on short-term survival. Results: The 50-point scoring system incorporated 12 recipient specific variables. Derivation and validation cohort scores ranged from 0 to 33 and 0 to 27, respectively (mean 6.1 ± 3.7 and 6.1 ± 3.7). Each point increased the odds of 1-year death by 14% in the derivation cohort (odds ratio 1.14 [1.13 to 1.15], p < 0.001) and 15% in the validation cohort (odds ratio 1.15 [1.12 to 1.17], p < 0001). One-year survivals in the validation cohort (by increments of 3 points) were the following: 0 to 2 (92.5%); 3 to 5 (89.9%); 7 to 9 (86.3%); and 10 or greater (74.9%); p < 0.001. Patients transplanted with risk scores of 20 or higher had 1-year mortality rates greater than 50%. Conclusions: We present a novel internally validated OHT recipient risk score, which is highly predictive of 1-year mortality. This risk index may prove valuable for patient prognosis, organ allocation, and research stratification in OHT. [ABSTRACT FROM AUTHOR] |
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